Provider Demographics
NPI:1477853877
Name:REDWOOD VALLEY HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:REDWOOD VALLEY HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR HEALTHCARE ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MULLNIX
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CHCA
Authorized Official - Phone:707-824-4880
Mailing Address - Street 1:8501 WEST RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-9583
Mailing Address - Country:US
Mailing Address - Phone:707-485-6900
Mailing Address - Fax:707-485-6909
Practice Address - Street 1:8501 WEST RD
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9583
Practice Address - Country:US
Practice Address - Phone:707-485-6900
Practice Address - Fax:707-485-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A64520Medicare PIN
CAF69792Medicare UPIN