Healthcare Provider Details

I. General information

NPI: 1720120116
Provider Name (Legal Business Name): SUTTER MEDICAL GROUP OF THE REDWOODS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 HOEN AVE
SANTA ROSA CA
95405-7824
US

IV. Provider business mailing address

3883 AIRWAY DR SUITE 300
SANTA ROSA CA
95403-1670
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-3360
  • Fax: 707-526-0554
Mailing address:
  • Phone: 707-521-8809
  • Fax: 707-521-8835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

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