Healthcare Provider Details

I. General information

NPI: 1164606117
Provider Name (Legal Business Name): CLAUDIA LEWIS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MARKET STREET
REDDING CA
96001
US

IV. Provider business mailing address

PO BOX 992790
REDDING CA
96099-2790
US

V. Phone/Fax

Practice location:
  • Phone: 530-247-7253
  • Fax:
Mailing address:
  • Phone: 530-246-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: