Healthcare Provider Details

I. General information

NPI: 1174549588
Provider Name (Legal Business Name): REDWOOD UROLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DOYLE PARK DR STE 303
SANTA ROSA CA
95405-4559
US

IV. Provider business mailing address

500 DOYLE PARK DR STE 303
SANTA ROSA CA
95405-4559
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-1833
  • Fax: 707-575-3561
Mailing address:
  • Phone: 707-575-1833
  • Fax: 707-575-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES PALLESCHI
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 707-575-1833