Healthcare Provider Details

I. General information

NPI: 1447341995
Provider Name (Legal Business Name): VINA K SWENSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VINA K AGRAWAL MD

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S OREGON ST
YREKA CA
96097
US

IV. Provider business mailing address

PO BOX 1340
YREKA CA
96097
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-2062
  • Fax: 530-842-2160
Mailing address:
  • Phone: 530-842-2062
  • Fax: 530-842-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA73189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: