Healthcare Provider Details

I. General information

NPI: 1588743264
Provider Name (Legal Business Name): REDWOOD REGIONAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SOTOYOME ST
SANTA ROSA CA
95405-4823
US

IV. Provider business mailing address

121 SOTOYOME ST
SANTA ROSA CA
95405-4823
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-4062
  • Fax: 707-525-4071
Mailing address:
  • Phone: 707-546-4062
  • Fax: 707-525-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF10300
License Number StateCA

VIII. Authorized Official

Name: DAVID H. SCHMIDT
Title or Position: M.D./RADIOLOGIST
Credential: M.D.
Phone: 707-546-4062