Healthcare Provider Details

I. General information

NPI: 1629139902
Provider Name (Legal Business Name): NUCLEAR MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 COURT ST
REDDING CA
96001-1823
US

IV. Provider business mailing address

1950 COURT ST
REDDING CA
96001-1823
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-8008
  • Fax: 530-225-8093
Mailing address:
  • Phone: 530-225-8008
  • Fax: 530-225-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number6066
License Number StateCA

VIII. Authorized Official

Name: DR. TIKOES A. BLANKENBERG
Title or Position: DIRECTOR
Credential: M.D.
Phone: 530-225-8008