Healthcare Provider Details

I. General information

NPI: 1073990842
Provider Name (Legal Business Name): DEREK HODSDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 MARKET ST
REDDING CA
96001-1023
US

IV. Provider business mailing address

1560 MARKET ST
REDDING CA
96001-1023
US

V. Phone/Fax

Practice location:
  • Phone: 530-245-7385
  • Fax: 530-225-3866
Mailing address:
  • Phone: 530-245-7385
  • Fax: 530-245-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: