Healthcare Provider Details

I. General information

NPI: 1609095900
Provider Name (Legal Business Name): CATHLEEN ANN MACLEAN RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MONTGOMERY RD
RED BLUFF CA
96080-4605
US

IV. Provider business mailing address

1530 FRANZEL RD PO BOX 516
RED BLUFF CA
96080-4147
US

V. Phone/Fax

Practice location:
  • Phone: 530-528-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA 12884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: