Healthcare Provider Details

I. General information

NPI: 1326287111
Provider Name (Legal Business Name): AMY KEURENTJES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 BUENAVENTURA BLVD SUITE B
REDDING CA
96001-3838
US

IV. Provider business mailing address

2216 BUENAVENTURA BLVD SUITE B
REDDING CA
96001-3838
US

V. Phone/Fax

Practice location:
  • Phone: 530-338-0002
  • Fax:
Mailing address:
  • Phone: 530-338-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A12413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: