Healthcare Provider Details

I. General information

NPI: 1477667384
Provider Name (Legal Business Name): FRONTIER VILLAGE FAMILY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 ANTELOPE BLVD STE 24
RED BLUFF CA
96080-2463
US

IV. Provider business mailing address

645 ANTELOPE BLVD STE 24
RED BLUFF CA
96080-2463
US

V. Phone/Fax

Practice location:
  • Phone: 530-528-7650
  • Fax: 530-528-7655
Mailing address:
  • Phone: 530-528-7650
  • Fax: 530-528-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAGRAJ S NIJJAR
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 530-528-7650