Healthcare Provider Details

I. General information

NPI: 1841204518
Provider Name (Legal Business Name): REDWOOD REGIONAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LYNCH CREEK WAY STE A
PETALUMA CA
94954-2337
US

IV. Provider business mailing address

110 LYNCH CREEK WAY STE A
PETALUMA CA
94954-2337
US

V. Phone/Fax

Practice location:
  • Phone: 707-763-0600
  • Fax: 707-765-1757
Mailing address:
  • Phone: 707-763-0600
  • Fax: 707-765-1757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0689028
License Number StateCA

VIII. Authorized Official

Name: HELEN COLLINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-546-4602