Healthcare Provider Details

I. General information

NPI: 1235192063
Provider Name (Legal Business Name): E GREGORY CEHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 COUNTRY RD
MEADOW VISTA CA
95722-9502
US

IV. Provider business mailing address

615 COUNTRY RD
MEADOW VISTA CA
95722-9502
US

V. Phone/Fax

Practice location:
  • Phone: 530-878-0170
  • Fax: 530-878-9925
Mailing address:
  • Phone: 530-878-0170
  • Fax: 530-878-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC037091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: