Healthcare Provider Details

I. General information

NPI: 1326154196
Provider Name (Legal Business Name): HUMBOLDT RADIOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 BUHNE ST
EUREKA CA
95501
US

IV. Provider business mailing address

PO BOX 6428
EUREKA CA
95502-6428
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-7814
  • Fax: 707-445-3710
Mailing address:
  • Phone: 707-442-7814
  • Fax: 707-445-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA JEAN ALBRIGHT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 707-442-7814