Healthcare Provider Details

I. General information

NPI: 1508927070
Provider Name (Legal Business Name): SUTTER MEDICAL GROUP OF THE REDWOODS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SONOMA AVE SUITE 316
SANTA ROSA CA
95405-4819
US

IV. Provider business mailing address

3883 AIRWAY DR SUITE 300
SANTA ROSA CA
95403-1670
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-9167
  • Fax: 707-575-4819
Mailing address:
  • Phone: 707-521-8809
  • Fax: 707-521-8835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA E ROCKSTROH
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 707-521-8809