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General NPI Number Information
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NPI Number | 1669734471
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Entity Type | Organization
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Legal Business Name | NAPA HEALTHY AGING INSTITUTE
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 3419 VALLE VERDE DR
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City | NAPA
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State | CA
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Zip | 94558-2414
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Country | US
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Telephone | 214-537-2080
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Fax | 707-282-9120
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Provider Business Mailing Address
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Address Line | 3419 VALLE VERDE DR
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City | NAPA
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State | CA
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Zip | 94558-2414
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Country | US
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Telephone | 214-537-2080
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Fax | 707-282-9120
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Authorized Official
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Title or Position | CFO, SECRETARY
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Name | GINA DOREEN KNUDSEN
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Credential | PA-C
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Telephone | 214-537-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | C54989
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License Number State | CA
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