Healthcare Provider Details

I. General information

NPI: 1053928606
Provider Name (Legal Business Name): NOR CAL TRAUMA HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 WINDMILL WAY STE 8
CARMICHAEL CA
95608-1379
US

IV. Provider business mailing address

5740 WINDMILL WAY STE 8
CARMICHAEL CA
95608-1379
US

V. Phone/Fax

Practice location:
  • Phone: 279-202-8113
  • Fax: 916-251-1148
Mailing address:
  • Phone: 279-202-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: VICTOR URREGO-VALLOWE
Title or Position: CHIEF FINANCIAL OFFICER
Credential: LCSW CCSP-ADHD
Phone: 279-202-8113