Healthcare Provider Details

I. General information

NPI: 1386746287
Provider Name (Legal Business Name): STEPHEN PACIA DATU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SALE LN SUITE A
RED BLUFF CA
96080-2949
US

IV. Provider business mailing address

85 SALE LN SUITE A
RED BLUFF CA
96080-2949
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-8688
  • Fax: 530-527-8561
Mailing address:
  • Phone: 530-527-8688
  • Fax: 530-527-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA48426
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA48426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: