Healthcare Provider Details

I. General information

NPI: 1851295661
Provider Name (Legal Business Name): CIRCUIT RIDER COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COLLEGE AVE
SANTA ROSA CA
95401-5119
US

IV. Provider business mailing address

9619 OLD REDWOOD HWY
WINDSOR CA
95492-9200
US

V. Phone/Fax

Practice location:
  • Phone: 707-838-6641
  • Fax:
Mailing address:
  • Phone: 707-838-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ROBERT TODD IZZO
Title or Position: CEO
Credential: PH.D.
Phone: 707-838-6641