Healthcare Provider Details

I. General information

NPI: 1629320254
Provider Name (Legal Business Name): TERRA YVETTE HESCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2413 2ND STREET
EUREKA CA
95501
US

IV. Provider business mailing address

904 G STREET
EUREKA CA
95501
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-9590
  • Fax: 707-444-8012
Mailing address:
  • Phone: 707-269-9590
  • Fax: 707-444-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: