| |
15230 Lakeshore Dr Clearlake CA 95422-8107 | |
(707) 995-4500 | |
(707) 994-2401 |
Full Name | |
---|---|
Speciality | Psychiatry & Neurology - Neurology |
Location | 15230 Lakeshore Dr, Clearlake, California |
Authorized Official Name and Position | Kaye A Donnelly (COORDINATOR) |
Authorized Official Contact | 7079682809 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
10 Woodland Rd Suite 502 Saint Helena CA 94574-9554 Ph: (707) 963-1882 | 15230 Lakeshore Dr Clearlake CA 95422-8107 Ph: (707) 995-4500 |
NPI Number | 1427209097 |
---|---|
Provider Enumeration Date | 10/01/2008 |
Last Update Date | 10/01/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427209097 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |