Healthcare Provider Details

I. General information

NPI: 1992470512
Provider Name (Legal Business Name): NREC PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 MAIN ST STE A
RED BLUFF CA
96080-3447
US

IV. Provider business mailing address

530 MAIN ST
RED BLUFF CA
96080-3438
US

V. Phone/Fax

Practice location:
  • Phone: 530-529-1750
  • Fax: 530-529-4551
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN HAUGEN
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 608-358-6901