Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | CA |
NPI | 1407239486 |
---|---|
Provider Name | Candice Lee Payne |
First Address | Red Bluff, CA 96080-2081 |
Second Address | Red Bluff, CA 96080-3359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2015 |
Last Update Date | 08/07/2015 |