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Organization
CCMMA CA PC
Active
Organization
CCMMA CA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE LADUCA (CREDENTIALING MANAGER)
(845) 702-2711
Entity
Organization
Contact information
Practice address
1100 BUTTE ST, REDDING, CA 96001-0852
(530) 244-5400
(888) 220-6560
Mailing address
PO BOX 631917, CINCINNATI, OH 45263-1917
(845) 702-2711
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
—
NULL
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
NULL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
NULL
207RP1001X
Pulmonary Disease Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
Other
Enumeration date
08/31/2022
Last updated
09/11/2025
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