Healthcare Provider Details

I. General information

NPI: 1639268667
Provider Name (Legal Business Name): SUTTER MEDICAL GROUP OF THE REDWOODS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 CHANATE RD SUITE 2C
SANTA ROSA CA
95404-1737
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 707-570-1130
  • Fax: 707-571-2478
Mailing address:
  • Phone: 707-521-8809
  • Fax: 707-521-8835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25179
License Number StateCA

VIII. Authorized Official

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