Provider Demographics
NPI:1366072571
Name:REDWOOD FOCUSED CARE CLINICS
Entity type:Organization
Organization Name:REDWOOD FOCUSED CARE CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAHIDULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHIDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-460-1919
Mailing Address - Street 1:286 M ST STE B
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-4115
Mailing Address - Country:US
Mailing Address - Phone:707-460-1919
Mailing Address - Fax:
Practice Address - Street 1:286 M ST STE B
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-4115
Practice Address - Country:US
Practice Address - Phone:707-460-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty