Healthcare Provider Details

I. General information

NPI: 1326236449
Provider Name (Legal Business Name): NEW DIRECTIONS MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 ARMORY DR SUITE 100
SANTA ROSA CA
95401-3610
US

IV. Provider business mailing address

2135 ARMORY DR SUITE 100
SANTA ROSA CA
95401-3610
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-1700
  • Fax: 707-575-1755
Mailing address:
  • Phone: 707-575-1700
  • Fax: 707-575-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG55246
License Number StateCA

VIII. Authorized Official

Name: DR. BRIAN S MOORE
Title or Position: PRESIDENT
Credential:
Phone: 707-575-1700