Healthcare Provider Details

I. General information

NPI: 1619064920
Provider Name (Legal Business Name): REDWOOD REGIONAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 HILL RD E STE F
LAKEPORT CA
95453-5100
US

IV. Provider business mailing address

5150 HILL RD E STE F
LAKEPORT CA
95453-5100
US

V. Phone/Fax

Practice location:
  • Phone: 707-262-3060
  • Fax: 707-262-3062
Mailing address:
  • Phone: 707-262-3060
  • Fax: 707-262-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0898449
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: HELEN L. COLLINS
Title or Position: M.D.
Credential: M.D.
Phone: 707-546-4062