Healthcare Provider Details

I. General information

NPI: 1215023056
Provider Name (Legal Business Name): REDWOOD ORTHOPAEDIC SURGERY ASSOCIATES AMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 CONCOURSE BLVD SUITE #1
SANTA ROSA CA
95403-8210
US

IV. Provider business mailing address

208 CONCOURSE BLVD SUITE #1
SANTA ROSA CA
95403-8210
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-3400
  • Fax: 707-544-3400
Mailing address:
  • Phone: 707-544-3400
  • Fax: 707-544-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberGR0046620
License Number StateCA

VIII. Authorized Official

Name: TARA ANN HOFF
Title or Position: PRACTICE ADMINISTRATOR
Credential: ATC
Phone: 707-755-5405