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Organization
LASSEN MEDICAL GROUP INC
Active
Organization
LASSEN MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM HAKE (MANAGER)
(530) 528-4419
Entity
Organization
Contact information
Practice address
20833 LONG BRANCH DR, COTTONWOOD, CA 96022-8701
(530) 347-3418
Mailing address
2450 SISTER MARY COLUMBA DRIVE, RED BLUFF, CA 96080
(530) 347-3418
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0089252
—
CA
05
—
RHM53957F
—
CA
Enumeration date
02/06/2007
Last updated
12/14/2012
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