| |
64105 Hillside Road Happy Camp CA 96039 | |
(530) 493-1450 | |
(530) 493-1451 |
Full Name | |
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Speciality | General Practice |
Location | 64105 Hillside Road, Happy Camp, California |
Authorized Official Name and Position | Eileen Mary Tiraterra (BUSINESS OFFICE DIRECTOR) |
Authorized Official Contact | 5304931600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1016 Happy Camp CA 96039-1016 Ph: (530) 493-5257 | 64105 Hillside Road Happy Camp CA 96039 Ph: (530) 493-1450 |
NPI Number | 1952483406 |
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Provider Enumeration Date | 10/20/2006 |
Last Update Date | 01/30/2025 |
Certification Date | 01/28/2025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952483406 | NPI | - | NPPES |
1952483406 | Medicaid | CA | |
1952483406 | Other | CA | MEDICARE |
1952483406 | Other | CA | NPI |
ZZZ09861Z | Other | CA | BLUE SHIELD OF CALIFORNIA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (California) | Secondary |
1223G0001X | Dentist - General Practice | (California) | Secondary |
208D00000X | General Practice | (California) | Primary |