Healthcare Provider Details

I. General information

NPI: 1316471402
Provider Name (Legal Business Name): COMP LEGAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 BRYSON DR
SUTTER CREEK CA
95685-4115
US

IV. Provider business mailing address

PO BOX 1885
SUTTER CREEK CA
95685-1885
US

V. Phone/Fax

Practice location:
  • Phone: 209-560-3113
  • Fax: 866-999-3744
Mailing address:
  • Phone: 209-560-3113
  • Fax: 866-999-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: TENIEJA QYNN NARCISSE-PERKINS
Title or Position: BILLING MANAGER/OWNER
Credential:
Phone: 209-560-3113