Healthcare Provider Details

I. General information

NPI: 1952402190
Provider Name (Legal Business Name): REDDING UROLOGIC ASSOCIATES, A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 EDITH AVE STE C
REDDING CA
96001-3056
US

IV. Provider business mailing address

2626 EDITH AVE STE C
REDDING CA
96001-3056
US

V. Phone/Fax

Practice location:
  • Phone: 530-241-3316
  • Fax: 530-241-6319
Mailing address:
  • Phone: 530-241-3316
  • Fax: 530-241-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: PATRICK T FOWLER
Title or Position: CORPORATION OFFICER
Credential: M.D.
Phone: 530-241-3316