Provider Demographics
NPI:1376510586
Name:ST. HELENA OB/GYN CLINIC
Entity Type:Organization
Organization Name:ST. HELENA OB/GYN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL GROUP COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-968-2870
Mailing Address - Street 1:15322 LAKESHORE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422-9814
Mailing Address - Country:US
Mailing Address - Phone:707-995-0193
Mailing Address - Fax:
Practice Address - Street 1:15322 LAKESHORE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-9814
Practice Address - Country:US
Practice Address - Phone:707-995-0193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00708ZMedicare ID - Type Unspecified