Healthcare Provider Details

I. General information

NPI: 1437375359
Provider Name (Legal Business Name): KIMBERLY A. PAGE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1388 COURT STREET SUITE H
REDDING CA
96001-1650
US

IV. Provider business mailing address

1388 COURT STREET SUITE H
REDDING CA
96001-1650
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-2207
  • Fax: 530-243-6835
Mailing address:
  • Phone: 530-246-2207
  • Fax: 530-243-6835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG64229
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: KIMBERLY A PAGE
Title or Position: MD/OWNER
Credential: MD
Phone: 530-246-2207