Healthcare Provider Details

I. General information

NPI: 1245241462
Provider Name (Legal Business Name): REDWOOD REGIONAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 MENDOCINO AVE STE 100
SANTA ROSA CA
95403-2276
US

IV. Provider business mailing address

3540 MENDOCINO AVE STE 100
SANTA ROSA CA
95403-2276
US

V. Phone/Fax

Practice location:
  • Phone: 707-528-3526
  • Fax: 707-528-6140
Mailing address:
  • Phone: 707-528-3526
  • Fax: 707-528-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HELEN COLLINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-546-4062