Healthcare Provider Details

I. General information

NPI: 1649664848
Provider Name (Legal Business Name): NORTHERN INYO ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 PIONEER LN SUITE D
BISHOP CA
93514-2563
US

IV. Provider business mailing address

152 PIONEER LN
BISHOP CA
93514-2563
US

V. Phone/Fax

Practice location:
  • Phone: 760-872-1606
  • Fax: 760-872-3463
Mailing address:
  • Phone: 760-873-5811
  • Fax: 760-873-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN WALLIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 760-873-2838