Healthcare Provider Details

I. General information

NPI: 1760638449
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

255 FARMERS LN
SANTA ROSA CA
95405-4721
US

IV. Provider business mailing address

3883 AIRWAY DR 300
SANTA ROSA CA
95403-1670
US

V. Phone/Fax

Practice location:
  • Phone: 707-545-2255
  • Fax:
Mailing address:
  • Phone: 707-521-8809
  • Fax: 707-521-8835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics 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