| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 325 Asip Rd, Orleans, 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 |
|---|---|
Po Box 1016 Happy Camp CA 96039-1016 Ph: (530) 493-1600 | 325 Asip Rd Orleans CA 95556-0249 Ph: (530) 627-3452 |
| NPI Number | 1386726032 |
|---|---|
| Provider Enumeration Date | 10/20/2006 |
| Last Update Date | 01/28/2025 |
| Certification Date | 01/28/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386726032 | NPI | - | NPPES |
| 1386726032 | Medicaid | CA | |
| 1386726032 | Other | CA | MEDICARE |
| ZZZ09862Z | Other | BLUE SHIELD OF CALIFORNIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |