Healthcare Provider Details

I. General information

NPI: 1356972756
Provider Name (Legal Business Name): MOBILE ONE URGENT CARE PHYSICIAN ASSISTANT OWNED APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3904 RAINIER DR
REDDING CA
96001-5914
US

IV. Provider business mailing address

PO BOX 991744
REDDING CA
96099-1744
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER JOHN BUCKLEY
Title or Position: OWNER
Credential: PA-C
Phone: 530-782-3791