Provider Demographics
NPI:1457565152
Name:HUMBOLDT DEL NORTE INDEPENDENT PRACTICE ASSOCIATION
Entity type:Organization
Organization Name:HUMBOLDT DEL NORTE INDEPENDENT PRACTICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-267-9580
Mailing Address - Street 1:2315 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3208
Mailing Address - Country:US
Mailing Address - Phone:707-443-4563
Mailing Address - Fax:707-443-2527
Practice Address - Street 1:2316 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3217
Practice Address - Country:US
Practice Address - Phone:707-442-0478
Practice Address - Fax:707-443-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10180OtherDEPT. MANAGEMENT HEALTHCA