Individual
DR. ANDRE' VAN MOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1755 COURT ST, REDDING, CA 96001-1721
(530) 247-8800
(530) 241-1174
Mailing address
3400 DATA DR, ATTN: CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G62379
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G623790
—
CA
01
—
68-0484253
TAX PAYER ID
CA
Enumeration date
10/20/2005
Last updated
11/07/2023
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