# SISKIYOU RURAL HOUSECALLS MEDICAL CORPORATION

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

## Provider details

- **NPI number:** 1871690057
- **Authorized official:** MS. JUDITH T. WALENTA FNP (PRESIDENT)
- **Authorized official phone:** (707) 884-9004

## Contact information

- **Practice address:** 1296 SCHEIBEL LN, SEBASTOPOL, CA 95472-4717
- **Practice address phone:** (707) 884-9004
- **Practice address fax:** (707) 823-3856
- **Mailing address:** 1296 SCHEIBEL LN, SEBASTOPOL, CA 95472-4717
- **Mailing address phone:** (707) 884-9004
- **Mailing address fax:** (707) 823-3856

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 20A5992 | CA | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01748003 | — | NY |