Healthcare Provider Details

I. General information

NPI: 1982956173
Provider Name (Legal Business Name): PET CARE VETERINARY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 MENDOCINO AVE.
SANTA ROSA CA
95403
US

IV. Provider business mailing address

1370 FUTTON RD
SANTA ROSA CA
95401
US

V. Phone/Fax

Practice location:
  • Phone: 707-579-3900
  • Fax: 707-303-3169
Mailing address:
  • Phone: 707-579-5900
  • Fax: 707-579-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number
License Number State

VIII. Authorized Official

Name: DR. ROGER BRADLEY
Title or Position: OWNER-SR. PARTNER
Credential: DVM
Phone: 707-579-3900