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General NPI Number Information
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NPI Number | 1841494366
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Entity Type | Organization
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Legal Business Name | NORTH VALLEY BREAST CLINIC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 1335 BUENAVENTURA BLVD SUITE # 204
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City | REDDING
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State | CA
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Zip | 96001-0160
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Country | US
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Telephone | 530-243-5551
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Fax | 530-245-0572
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Provider Business Mailing Address
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Address Line | 1335 BUENAVENTURA BLVD SUITE # 204
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City | REDDING
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State | CA
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Zip | 96001-0160
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Country | US
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Telephone | 530-243-5551
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Fax | 530-245-0572
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Authorized Official
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Title or Position | OWNER
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Name | DR. IAN P GRADY
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Credential | MD
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Telephone | 530-243-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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