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General NPI Number Information
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NPI Number | 1376669481
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Entity Type | Organization
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Legal Business Name | REDDING PRIMARY CARE MEDICAL GROUP, INC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 1093 HILLTOP DR
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City | REDDING
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State | CA
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Zip | 96003-3811
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Country | US
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Telephone | 530-221-1565
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Fax | 530-221-3912
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Provider Business Mailing Address
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Address Line | 1093 HILLTOP DR
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City | REDDING
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State | CA
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Zip | 96003-3811
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Country | US
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Telephone | 530-221-1565
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Fax | 530-221-3912
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LINDA YVONNE FULLERTON
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Credential |
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Telephone | 530-221-1565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | BUSS LIC# 23151
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License Number State | CA
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