Healthcare Provider Details

I. General information

NPI: 1255034088
Provider Name (Legal Business Name): COMPREHENSIVE SURGICAL CARE OF REDDING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 SONOMA ST
REDDING CA
96001-3026
US

IV. Provider business mailing address

2439 SONOMA ST
REDDING CA
96001-3026
US

V. Phone/Fax

Practice location:
  • Phone: 480-591-9345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOEL RAINWATER
Title or Position: PRESIDENT
Credential:
Phone: 480-219-0123