Healthcare Provider Details

I. General information

NPI: 1871522110
Provider Name (Legal Business Name): GARY L MIGUEL P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/07/2020
Certification Date: 11/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1093 HILLTOP DR
REDDING CA
96003-3811
US

IV. Provider business mailing address

1093 HILLTOP DR
REDDING CA
96003-3811
US

V. Phone/Fax

Practice location:
  • Phone: 530-221-1565
  • Fax: 530-221-3912
Mailing address:
  • Phone: 530-221-1565
  • Fax: 530-221-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10123
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA10123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: