Healthcare Provider Details

I. General information

NPI: 1427735612
Provider Name (Legal Business Name): PACIFIC INTERVENTIONAL NEUROSCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 SONOMA STREET
REDDING CA
96001-3033
US

IV. Provider business mailing address

2420 SONOMA STREET
REDDING CA
96001-3033
US

V. Phone/Fax

Practice location:
  • Phone: 530-999-2533
  • Fax: 530-999-2532
Mailing address:
  • Phone: 530-999-2533
  • Fax: 530-999-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER JOSEPH SUNENSHINE
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 530-999-2533