Provider Demographics
NPI:1215949722
Name:NAMIHAS, BRET NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:NICHOLAS
Last Name:NAMIHAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-244-3622
Mailing Address - Fax:530-244-1029
Practice Address - Street 1:1825 SONOMA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2519
Practice Address - Country:US
Practice Address - Phone:530-243-8667
Practice Address - Fax:530-243-8742
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G587910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G587910OtherLIC
CAZZZ30119ZOtherMCARE GROUP ID
CA00G587910OtherLIC
CAZZZ30119ZOtherMCARE GROUP ID
CAE25134Medicare UPIN