Mt Diablo Integrated Wellness Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A67699 Issued in CA

Legal business name

MT DIABLO INTEGRATED WELLNESS INC

Practice address

325 N Wiget LN
Suite 130
Walnut Creek, CA 94598-2435

Phone

(925) 935-5425

Fax

(925) 947-2671

NPI assigned

Aug 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Suprabha N Jain, M.DNPI 1841228384

Title

Owner

Phone

(925) 935-5425

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Suprabha N Jain, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Pleasant Hill, CA
  • NPI 1841228384
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487808000000",
    "number": "1265623110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 N WIGET LN",
            "address_2": "SUITE 130",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982435",
            "telephone_number": "925-935-5425",
            "fax_number": "925-947-2671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N WIGET LN",
            "address_2": "SUITE 130",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982435",
            "telephone_number": "925-935-5425",
            "fax_number": "925-947-2671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT DIABLO INTEGRATED WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-06",
        "last_updated": "2017-02-23",
        "status": "A",
        "authorized_official_last_name": "JAIN",
        "authorized_official_first_name": "SUPRABHA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "925-935-5425",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A67699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "ZZZ05648Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Moussa F Yazbeck MD Inc
• Teniyah Mouton
• Jason Frederick Moy, MD
• Nancy Broitman Mozelsio, MD
• Mekenna Renee Mroskey, N.P.
• Mt Diablo Memory Center, a Psychological Corporation
• Theresa Ann Mueller, RN
• Jakala Muhammad
• Sharon Muhlenkort, PHD
• Rebecca Mui, PHARMD

• Specialist in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.