Provider Demographics
NPI:1174155766
Name:GINA RENEE PALADY
Entity type:Organization
Organization Name:GINA RENEE PALADY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALADY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:530-206-3424
Mailing Address - Street 1:404 N MOUNT SHASTA BLVD # 350
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2232
Mailing Address - Country:US
Mailing Address - Phone:530-206-3424
Mailing Address - Fax:831-886-5750
Practice Address - Street 1:407 S MOUNT SHASTA BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2559
Practice Address - Country:US
Practice Address - Phone:530-206-3424
Practice Address - Fax:831-886-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty