Healthcare Provider Details

I. General information

NPI: 1225103369
Provider Name (Legal Business Name): HEALTHY STEPS WEIGHT LOSS CENTER MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 HOEN AVENUE
SANTA ROSA CA
95405
US

IV. Provider business mailing address

4730 HOEN AVENUE
SANTA ROSA CA
95405
US

V. Phone/Fax

Practice location:
  • Phone: 707-577-7800
  • Fax: 707-525-0538
Mailing address:
  • Phone: 707-577-7800
  • Fax: 707-525-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT O WOODBURY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-577-7800