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General NPI Number Information
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NPI Number | 1992470512
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Entity Type | Organization
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Legal Business Name | NREC PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 508 MAIN ST STE A
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City | RED BLUFF
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State | CA
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Zip | 96080-3447
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Country | US
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Telephone | 530-529-1750
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Fax | 530-529-4551
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Provider Business Mailing Address
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Address Line | 530 MAIN ST
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City | RED BLUFF
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State | CA
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Zip | 96080-3438
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BRIAN HAUGEN
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Credential |
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Telephone | 608-358-6901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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