=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174792741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEE E. VRANNA, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2008
-----------------------------------------------------
Last Update Date | 02/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1135 WHISKEYTOWN CT
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-0227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-245-0965
-----------------------------------------------------
Fax | 530-245-0539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1135 WHISKEYTOWN CT
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-0227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-245-0965
-----------------------------------------------------
Fax | 530-245-0539
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LEE EUGENE VRANNA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 530-245-0965
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number | G58584
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------