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General NPI Number Information
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NPI Number | 1457565152
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Entity Type | Organization
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Legal Business Name | HUMBOLDT DEL NORTE INDEPENDENT PRACTICE ASSOCIATION
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 2316 HARRISON AVE
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City | EUREKA
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State | CA
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Zip | 95501-3217
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Country | US
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Telephone | 707-442-0478
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Fax | 707-443-2527
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Provider Business Mailing Address
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Address Line | 2315 DEAN ST
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City | EUREKA
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State | CA
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Zip | 95501-3208
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Country | US
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Telephone | 707-443-4563
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Fax | 707-443-2527
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | LISA GREEN
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Credential |
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Telephone | 707-267-9580
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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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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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