Healthcare Provider Details

I. General information

NPI: 1558873786
Provider Name (Legal Business Name): SAMUEL C BIRKHOLZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 BRUCE ST
YREKA CA
96097-3450
US

IV. Provider business mailing address

444 BRUCE ST
YREKA CA
96097-3450
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-4121
  • Fax: 530-841-2049
Mailing address:
  • Phone: 530-842-4124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: