Healthcare Provider Details

I. General information

NPI: 1689208662
Provider Name (Legal Business Name): LYDIA MCGAFFEE BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3657 RICARDO AVE
REDDING CA
96002-2627
US

IV. Provider business mailing address

3657 RICARDO AVE
REDDING CA
96002-2627
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-9007
  • Fax:
Mailing address:
  • Phone: 530-242-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: