Healthcare Provider Details

I. General information

NPI: 1982963583
Provider Name (Legal Business Name): CAREY ANNE VENGLARCIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1125
US

IV. Provider business mailing address

2217 HARLAN DR
REDDING CA
96003-3476
US

V. Phone/Fax

Practice location:
  • Phone: 530-229-5116
  • Fax:
Mailing address:
  • Phone: 330-540-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA126194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: