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General NPI Number Information
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NPI Number | 1871252569
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Entity Type | Organization
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Legal Business Name | REDDING RANCHERIA
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 3110 CHURN CREEK RD
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City | REDDING
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State | CA
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Zip | 96002-2101
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Country | US
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Telephone | 530-226-1740
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Fax | 530-224-2738
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Provider Business Mailing Address
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Address Line | 1441 LIBERTY ST
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City | REDDING
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State | CA
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Zip | 96001-0811
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Country | US
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Telephone | 530-226-1740
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Fax | 530-224-2738
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | TAMRA DAWN OLSON
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Credential |
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Telephone | 530-242-4523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry 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 | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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