Healthcare Provider Details

I. General information

NPI: 1922419860
Provider Name (Legal Business Name): NORTHSTATE CARDIOLOGY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 COHASSET RD
CHICO CA
95926-2202
US

IV. Provider business mailing address

198 COHASSET RD
CHICO CA
95926-2202
US

V. Phone/Fax

Practice location:
  • Phone: 530-342-0123
  • Fax: 530-342-6475
Mailing address:
  • Phone: 530-342-0123
  • Fax: 530-342-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 51596
License Number StateCA

VIII. Authorized Official

Name: ALEXANDRA L SHAND
Title or Position: MANAGER
Credential:
Phone: 530-342-0123