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General NPI Number Information
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NPI Number | 1114476413
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Entity Type | Organization
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Legal Business Name | WITH OPEN ARMS / REPRODUCTIVE HEALTH CARE SERVICES LLC
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 2505 LUCAS ST STE B
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City | EUREKA
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State | CA
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Zip | 95501-3340
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Country | US
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Telephone | 707-442-0400
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Fax | 707-442-0404
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Provider Business Mailing Address
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Address Line | 2505 LUCAS ST STE B
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City | EUREKA
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State | CA
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Zip | 95501-3340
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Country | US
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Telephone | 707-442-0400
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Fax | 707-442-0404
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY PAIK-NICELY
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Credential | M.D.
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Telephone | 707-442-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | NMW 235678
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G44510
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License Number State | CA
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