Healthcare Provider Details

I. General information

NPI: 1285869966
Provider Name (Legal Business Name): GREGORY SEAN HADFIELD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2009
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 N FORBES ST STE B
LAKEPORT CA
95453-4725
US

IV. Provider business mailing address

475 N FORBES ST STE B
LAKEPORT CA
95453-4725
US

V. Phone/Fax

Practice location:
  • Phone: 707-606-6366
  • Fax:
Mailing address:
  • Phone: 760-709-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberP-16311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: