Healthcare Provider Details

I. General information

NPI: 1841342128
Provider Name (Legal Business Name): HUMBOLDT RADIOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 CEDAR ST
GARBERVILLE CA
95542-3201
US

IV. Provider business mailing address

PO BOX 6428
EUREKA CA
95502-6428
US

V. Phone/Fax

Practice location:
  • Phone: 707-923-3921
  • Fax:
Mailing address:
  • Phone: 707-445-5431
  • 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: MRS. NANCY LOUISE COBINE
Title or Position: BILLING MANAGER
Credential:
Phone: 707-445-5431