Healthcare Provider Details

I. General information

NPI: 1053122010
Provider Name (Legal Business Name): ENLOE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 BRUCE RD STE 100
CHICO CA
95928-7945
US

IV. Provider business mailing address

1531 ESPLANADE
CHICO CA
95926-3310
US

V. Phone/Fax

Practice location:
  • Phone: 530-332-3680
  • Fax:
Mailing address:
  • Phone: 530-332-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE VENARD
Title or Position: DIRECTOR, PFS
Credential:
Phone: 530-332-6331