Healthcare Provider Details

I. General information

NPI: 1871058156
Provider Name (Legal Business Name): FLORA GEORGE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FLORA LAWRENCE PA

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 LIBERTY ST
REDDING CA
96001-0814
US

IV. Provider business mailing address

1255 LIBERTY ST
REDDING CA
96001-0814
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-2467
  • Fax: 530-242-9460
Mailing address:
  • Phone: 530-246-2467
  • Fax: 530-242-9460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0006097
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: