Healthcare Provider Details

I. General information

NPI: 1184363913
Provider Name (Legal Business Name): IRENE CONTRERAS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 CEANOTHUS AVE
CHICO CA
95973-7615
US

IV. Provider business mailing address

1565 HOBART ST
CHICO CA
95926-3726
US

V. Phone/Fax

Practice location:
  • Phone: 530-892-2810
  • Fax:
Mailing address:
  • Phone: 530-961-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number070502045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: