Healthcare Provider Details

I. General information

NPI: 1942690300
Provider Name (Legal Business Name): RANDY HELWIG R.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9707
US

IV. Provider business mailing address

8129 PONDEROSA WAY
MOUNTAIN RANCH CA
95246-9469
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-2666
  • Fax:
Mailing address:
  • Phone: 209-754-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number955336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: