Healthcare Provider Details

I. General information

NPI: 1649260126
Provider Name (Legal Business Name): QUEEN OF THE VALLEY MEDICAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TRANCAS ST SUITE 209
NAPA CA
94558-2908
US

IV. Provider business mailing address

1100 TRANCAS ST SUITE 209
NAPA CA
94558-2908
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-4411
  • Fax: 707-251-1860
Mailing address:
  • Phone: 707-252-4411
  • Fax: 707-251-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA35569
License Number StateCA

VIII. Authorized Official

Name: DR. ROGER BRUCE SCARBOROUGH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 707-252-4411