MEDICARE: GREENVILLE RANCHERIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1669328308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE RANCHERIA

Provider Business Mailing Address
First Line	:	PO BOX 279
Second Line	:
City	:	GREENVILLE
State	:	CA
Zip	:	95947-0279
Country	:	US
Telephone Number	:	530-284-6135
Fax Number	:

Provider Business Practice Location Address
First Line	:	2139 AIRPARK DR
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-2433
Country	:	US
Telephone Number	:	530-247-0270
Fax Number	:

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	ROSA GONZALEZ
Credential	:
Telephone Number	:	530-528-8600

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “GREENVILLE RANCHERIA ” Practice Location

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