Healthcare Provider Details

I. General information

NPI: 1962587964
Provider Name (Legal Business Name): NORTHERN CALIFORNIA CENTER FOR WELL-BEING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DOYLE PARK DR STE 304A
SANTA ROSA CA
95405-4558
US

IV. Provider business mailing address

PO BOX 3644
SANTA ROSA CA
95402-3644
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-6043
  • Fax: 707-575-1060
Mailing address:
  • Phone: 707-575-6043
  • Fax: 707-575-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JEANETTE PEREZ
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 707-387-5612