Healthcare Provider Details

I. General information

NPI: 1366628224
Provider Name (Legal Business Name): SUTTER MEDICAL GROUP OF THE REDWOODS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DOYLE PARK DR STE. 303
SANTA ROSA CA
95405-4558
US

IV. Provider business mailing address

3883 AIRWAY DR STE 300
SANTA ROSA CA
95403-1671
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-1833
  • Fax: 707-575-1892
Mailing address:
  • Phone: 707-521-8809
  • Fax: 707-521-8835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LINDA E ROCKSTROH
Title or Position: CREDENTIALING ADMINISTRATIVE ASSIST
Credential:
Phone: 707-521-8809