# CCMMA CA PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679293443
- **Authorized official:** LAURIE LADUCA (CREDENTIALING MANAGER)
- **Authorized official phone:** (845) 702-2711

## Contact information

- **Practice address:** 1100 BUTTE ST, REDDING, CA 96001-0852
- **Practice address phone:** (530) 244-5400
- **Practice address fax:** (888) 220-6560
- **Mailing address:** PO BOX 631917, CINCINNATI, OH 45263-1917
- **Mailing address phone:** (845) 702-2711

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LC0200X | Critical Care Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LC0200X | Critical Care Medicine (Anesthesiology) Physician | — | — | Yes |
| 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