Healthcare Provider Details

I. General information

NPI: 1154577831
Provider Name (Legal Business Name): SUTTER MEDICAL GROUP OF THE REDWOODS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DOYLE PARK D. 200
SANTA ROSA CA
95405
US

IV. Provider business mailing address

3883 AIRWAY DR 300
SANTA ROSA CA
95403-1671
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-8809
  • Fax: 707-521-8835
Mailing address:
  • Phone: 707-303-8310
  • Fax: 707-545-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN E LEVENBERG
Title or Position: PRESIDENT
Credential: D.O.
Phone: 707-521-8879