Healthcare Provider Details

I. General information

NPI: 1699372326
Provider Name (Legal Business Name): ADVENTIST HEALTH PHYSICIANS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 MADRONE ST STE A
WILLITS CA
95490-4249
US

IV. Provider business mailing address

PO BOX 888794
LOS ANGELES CA
90088-8794
US

V. Phone/Fax

Practice location:
  • Phone: 707-456-3062
  • Fax: 707-456-3063
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: ARBY NAHAPETIAN
Title or Position: PRESIDENT
Credential:
Phone: 702-271-4998