MEDICARE: DR. ADINA MANUELA LOGAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	C193919	CA

General Provider Information

NPI Number	:	1881667178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADINA MANUELA LOGAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 276950
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-6950
Country	:	US
Telephone Number	:	707-308-2800
Fax Number	:	707-573-5406

Provider Business Practice Location Address
First Line	:	4702 HOEN AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-7824
Country	:	US
Telephone Number	:	707-308-2800
Fax Number	:	707-573-5406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	11/26/2024

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