Basic Information
| Provider Information | |||||||||
| NPI: | 1518252550 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REDWOOD FAMILY PRACTICE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2350 BUHNE ST STE A | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955013205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074434593 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2350 BUHNE ST STE A | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955013205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074434593 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 08/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7074434593 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.