Provider Demographics
NPI:1144500562
Name:CALIFORNIA OCCUPATIONAL MEDICAL PROFESSIONALS
Entity type:Organization
Organization Name:CALIFORNIA OCCUPATIONAL MEDICAL PROFESSIONALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CALLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUARELS LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:530-534-5135
Mailing Address - Street 1:PO BOX 2055
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-2055
Mailing Address - Country:US
Mailing Address - Phone:530-534-5135
Mailing Address - Fax:530-532-0259
Practice Address - Street 1:1940 FEATHER RIVER BLVD
Practice Address - Street 2:SUITE #O
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5723
Practice Address - Country:US
Practice Address - Phone:530-534-5135
Practice Address - Fax:530-532-0259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA 194OtherLABORATORY ID