Healthcare Provider Details

I. General information

NPI: 1295453090
Provider Name (Legal Business Name): MICARE CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 N CLOVIS AVE STE 102
CLOVIS CA
93612-0524
US

IV. Provider business mailing address

PO BOX 21367
BILLINGS MT
59104-1367
US

V. Phone/Fax

Practice location:
  • Phone: 559-327-2873
  • Fax:
Mailing address:
  • Phone: 406-245-3575
  • Fax: 406-652-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENNA YARINA
Title or Position: PRIVACY OFFICER
Credential:
Phone: 406-245-3575