Healthcare Provider Details

I. General information

NPI: 1710334677
Provider Name (Legal Business Name): NEPOMUCENO HOSPITAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HARTNELL AVE
REDDING CA
96002-1843
US

IV. Provider business mailing address

PO BOX 992337
REDDING CA
96099-2337
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC50728
License Number StateCA

VIII. Authorized Official

Name: JOHN NEPOMUCENO
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 702-453-3799