Healthcare Provider Details

I. General information

NPI: 1891307120
Provider Name (Legal Business Name): JAMIE RENAE NJIRICH MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE RENAE CASSIDY MT

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 MAIN ST
RED BLUFF CA
96080-2373
US

IV. Provider business mailing address

2050 MAIN ST
RED BLUFF CA
96080-2373
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-0121
  • Fax: 530-527-0179
Mailing address:
  • Phone: 530-527-0121
  • Fax: 530-527-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number83249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: