OrganizationActive
Innerbloom Ketamine Therapy
NPI 1184430696 · Integrative Medicine Physician · San Luis Obispo, CA
Provider details
- NPI number
- 1184430696
- Entity type
- Organization
- Primary specialty
- Integrative Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Ray Rivas, MD(805) 321-8471
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
100 Casa St Ste D3
San Luis Obispo, CA 93405-5827
Phone: (805) 321-8471
Fax: (805) 567-6604
Approximate (ZIP-level) locationGet directions
Mailing address
100 Casa St Ste D3
San Luis Obispo, CA 93405-5827
Registry dates
- Enumerated
- 2024-12-09
- Last updated
- 2026-03-03
- Certified
- 2026-03-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.