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General NPI Number Information
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NPI Number | 1295453090
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Entity Type | Organization
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Legal Business Name | MICARE CALIFORNIA PC
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 362 N CLOVIS AVE STE 102
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City | CLOVIS
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State | CA
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Zip | 93612-0524
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Country | US
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Telephone | 559-327-2873
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21367
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City | BILLINGS
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State | MT
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Zip | 59104-1367
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Country | US
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Telephone | 406-245-3575
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Fax | 406-652-5380
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Authorized Official
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Title or Position | PRIVACY OFFICER
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Name | BRENNA YARINA
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Credential |
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Telephone | 406-245-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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