Healthcare Provider Details

I. General information

NPI: 1164977005
Provider Name (Legal Business Name): ANDO MUNENO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2016
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 KNOLLCREST DR STE 101
REDDING CA
96002-0181
US

IV. Provider business mailing address

415 KNOLLCREST DR STE 101
REDDING CA
96002-0181
US

V. Phone/Fax

Practice location:
  • Phone: 530-392-4399
  • Fax:
Mailing address:
  • Phone: 530-392-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number56655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: