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General NPI Number Information
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NPI Number | 1316471402
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Entity Type | Organization
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Legal Business Name | COMP LEGAL MEDICAL GROUP
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 71 BRYSON DR
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City | SUTTER CREEK
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State | CA
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Zip | 95685-4115
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Country | US
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Telephone | 209-560-3113
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Fax | 866-999-3744
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Provider Business Mailing Address
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Address Line | PO BOX 1885
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City | SUTTER CREEK
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State | CA
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Zip | 95685-1885
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Country | US
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Telephone | 209-560-3113
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Fax | 866-999-3744
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Authorized Official
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Title or Position | BILLING MANAGER/OWNER
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Name | TENIEJA QYNN NARCISSE-PERKINS
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Credential |
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Telephone | 209-560-3113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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