Healthcare Provider Details

I. General information

NPI: 1134039761
Provider Name (Legal Business Name): FLOURISH MIDLIFE MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SHADOWBROOK ST
LOLETA CA
95551-9409
US

IV. Provider business mailing address

PO BOX 240
LOLETA CA
95551-0240
US

V. Phone/Fax

Practice location:
  • Phone: 530-520-0014
  • Fax: 707-783-2963
Mailing address:
  • Phone: 530-520-0014
  • Fax: 707-783-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NOELLE E GUNN
Title or Position: VICE PRESIDENT
Credential: NP
Phone: 530-520-0014