Healthcare Provider Details

I. General information

NPI: 1932305968
Provider Name (Legal Business Name): NORTH COAST MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 SUMMERFIELD RD
SANTA ROSA CA
95405-7815
US

IV. Provider business mailing address

4704 HOEN AVENUE
SANTA ROSA CA
95405
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-7979
  • Fax: 707-546-7667
Mailing address:
  • Phone: 707-546-7979
  • Fax: 707-546-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG085353
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL L TRAN
Title or Position: OWNER DOCTOR
Credential: MD
Phone: 707-546-7979