Provider Demographics
NPI:1508927344
Name:NEWSTART MEDICAL CLINIC
Entity Type:Organization
Organization Name:NEWSTART MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-637-4111
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95736
Mailing Address - Country:US
Mailing Address - Phone:530-637-4111
Mailing Address - Fax:530-637-4443
Practice Address - Street 1:20601 WEST PAOLI LANE
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:CA
Practice Address - Zip Code:95736
Practice Address - Country:US
Practice Address - Phone:530-637-4111
Practice Address - Fax:530-637-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22926ZOtherCLINIC PROVIDER #