Healthcare Provider Details

I. General information

NPI: 1811242563
Provider Name (Legal Business Name): SUTTER WEST BAY MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SONOMA AVE STE 2
SANTA ROSA CA
95405-6664
US

IV. Provider business mailing address

2015 STEINER ST
SAN FRANCISCO CA
94115-2627
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-2192
  • Fax: 707-571-2194
Mailing address:
  • Phone: 415-600-4280
  • Fax: 415-600-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J. COHILL
Title or Position: PRESIDENT
Credential:
Phone: 415-600-7771