Healthcare Provider Details

I. General information

NPI: 1275685414
Provider Name (Legal Business Name): GATEWAY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3082 MCMURRAY DR
ANDERSON CA
96007
US

IV. Provider business mailing address

3082 MCMURRAY DR
ANDERSON CA
96007
US

V. Phone/Fax

Practice location:
  • Phone: 530-365-4412
  • Fax: 530-365-5186
Mailing address:
  • Phone: 530-365-4412
  • Fax: 530-365-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A5484
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANY LOCKHART REGUERA
Title or Position: DIRECTOR
Credential: F.N.P.
Phone: 530-365-4412