Healthcare Provider Details

I. General information

NPI: 1801992128
Provider Name (Legal Business Name): WOMENS OB/GYN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DOYLE PARK DRIVE SUITE 103
SANTA ROSA CA
95405-9559
US

IV. Provider business mailing address

500 DOYLE PARK DRIVE SUITE 103
SANTA ROSA CA
95405-9559
US

V. Phone/Fax

Practice location:
  • Phone: 707-579-1102
  • Fax: 707-579-1386
Mailing address:
  • Phone: 707-579-1102
  • Fax: 707-579-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DONA ROMANO
Title or Position: MANAGER
Credential:
Phone: 707-579-1102