Healthcare Provider Details

I. General information

NPI: 1558234872
Provider Name (Legal Business Name): JAMES BLACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 RIO LINDO AVE
CHICO CA
95926-1817
US

IV. Provider business mailing address

2723 MITCHELL AVE APT 6
OROVILLE CA
95966-5461
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2775
  • Fax:
Mailing address:
  • Phone: 775-220-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: