Healthcare Provider Details

I. General information

NPI: 1841962198
Provider Name (Legal Business Name): JOHN DENSMORE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 BUENAVENTURA BLVD
REDDING CA
96001-3700
US

IV. Provider business mailing address

4001 W MCNICHOLS RD
DETROIT MI
48221-3038
US

V. Phone/Fax

Practice location:
  • Phone: 530-986-9160
  • Fax:
Mailing address:
  • Phone:
  • Fax: 530-986-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: