Provider Demographics
NPI:1326172354
Name:POWERS, JAMES MICHAEL (CAS INTERN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:POWERS
Suffix:
Gender:M
Credentials:CAS INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13419 MCKITRICK RANCH RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9740
Mailing Address - Country:US
Mailing Address - Phone:530-559-7776
Mailing Address - Fax:
Practice Address - Street 1:145 BOST AVE
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3249
Practice Address - Country:US
Practice Address - Phone:530-265-9045
Practice Address - Fax:530-478-7977
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1863OtherCAS