Healthcare Provider Details

I. General information

NPI: 1316338056
Provider Name (Legal Business Name): SITE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 BROADWAY
EUREKA CA
95501-0129
US

IV. Provider business mailing address

1833 FILLMORE ST SUITE 100
SAN FRANCISCO CA
94115-3180
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-2922
  • Fax: 707-442-7206
Mailing address:
  • Phone: 510-301-8317
  • Fax: 510-225-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CAMBRA
Title or Position: PRESIDENT
Credential: RSLD
Phone: 510-301-8317