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Organization
NORTH VALLEY BREAST CLINIC
Active
Organization
NORTH VALLEY BREAST CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IAN P GRADY MD (OWNER)
(530) 243-5551
Entity
Organization
Contact information
Practice address
1335 BUENAVENTURA BLVD, SUITE # 204, REDDING, CA 96001-0160
(530) 243-5551
(530) 245-0572
Mailing address
1335 BUENAVENTURA BLVD, SUITE # 204, REDDING, CA 96001-0160
(530) 243-5551
(530) 245-0572
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ53955Y
BLUE SHIELD
CA
Enumeration date
06/11/2007
Last updated
07/16/2012
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