Healthcare Provider Details

I. General information

NPI: 1154886166
Provider Name (Legal Business Name): LIFEWEST NORTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 PORTAL ST
COTATI CA
94931-3060
US

IV. Provider business mailing address

PO BOX 2930
SANTA ROSA CA
95405-0930
US

V. Phone/Fax

Practice location:
  • Phone: 707-755-5060
  • Fax: 707-755-5067
Mailing address:
  • Phone: 800-811-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: SEAN SULLIVAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 707-766-2404