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General NPI Number Information
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NPI Number | 1437267911
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Entity Type | Organization
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Legal Business Name | NEPOMUCENO, MD, INC.
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Dates
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Enumeration Date | 08/26/2006
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 15660 MIDDLETOWN PARK DR
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City | REDDING
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State | CA
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Zip | 96001-9794
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Country | US
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Telephone | 530-244-1003
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Fax | 530-242-6027
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Provider Business Mailing Address
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Address Line | PO BOX 994463
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City | REDDING
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State | CA
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Zip | 96099-4463
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Country | US
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Telephone | 530-244-1003
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Fax | 530-242-6026
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN E NEPOMUCENO
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Credential | M.D.
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Telephone | 530-244-1003
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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 | C50728
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License Number State | CA
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