Healthcare Provider Details

I. General information

NPI: 1154523447
Provider Name (Legal Business Name): SANTA ROSA CARDIAC IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SONOMA AVE SUITE 108
SANTA ROSA CA
95405-4819
US

IV. Provider business mailing address

500 DOYLE PARK DR SUITE 205
SANTA ROSA CA
95405-4558
US

V. Phone/Fax

Practice location:
  • Phone: 707-636-0190
  • Fax: 707-636-0220
Mailing address:
  • Phone: 707-527-8444
  • Fax: 707-527-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. JAN E CARTEE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 707-527-5155