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General NPI Number Information
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NPI Number | 1982615779
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Entity Type | Organization
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Legal Business Name | CANCER CARE CONSULTANTS OF NORTHERN CALIFORNIA A MEDICAL GROUP
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 902 PINE ST
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-2143
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Country | US
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Telephone | 530-926-7234
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Fax | 530-926-7231
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Provider Business Mailing Address
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Address Line | PO BOX 993100
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City | REDDING
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State | CA
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Zip | 96099-3100
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Country | US
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Telephone | 530-244-2223
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Fax | 530-244-4799
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | JENNIFER STAHL
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Credential |
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Telephone | 530-244-2223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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