Healthcare Provider Details

I. General information

NPI: 1497816011
Provider Name (Legal Business Name): ORTHOPAEDIC TRAUMA SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2662 EDITH AVE
REDDING CA
96001
US

IV. Provider business mailing address

2662 EDITH AVE
REDDING CA
96001
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-1266
  • Fax: 530-243-4205
Mailing address:
  • Phone: 530-242-1266
  • Fax: 530-243-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number20A9141
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number20A9141
License Number StateCA

VIII. Authorized Official

Name: LISA R VANDEBURG
Title or Position: OFFICE MANAGER
Credential:
Phone: 530-242-1266