Provider Demographics
NPI:1295453090
Name:MICARE CALIFORNIA PC
Entity type:Organization
Organization Name:MICARE CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:YARINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-245-3575
Mailing Address - Street 1:PO BOX 21367
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-1367
Mailing Address - Country:US
Mailing Address - Phone:406-245-3575
Mailing Address - Fax:406-652-5380
Practice Address - Street 1:362 N CLOVIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0524
Practice Address - Country:US
Practice Address - Phone:559-327-2873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty