Healthcare Provider Details

I. General information

NPI: 1336601517
Provider Name (Legal Business Name): NATHAN BIRNBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3569 ROUND BARN CIR
SANTA ROSA CA
95403-5781
US

IV. Provider business mailing address

3569 ROUND BARN CIR
SANTA ROSA CA
95403-5781
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-3600
  • Fax: 707-303-3601
Mailing address:
  • Phone: 707-303-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC211737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: