Healthcare Provider Details

I. General information

NPI: 1861693566
Provider Name (Legal Business Name): SUTTER VALLEY MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 MENDOCINO AVE SUITE 300
SANTA ROSA CA
95403-3634
US

IV. Provider business mailing address

15620 HEALDSBURG AVE
HEALDSBURG CA
95448-9617
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-1280
  • Fax: 707-578-5849
Mailing address:
  • Phone: 707-475-4531
  • Fax: 707-473-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KRISTA LOPES
Title or Position: SH VP, QUALITY, SAFETY, PATIENT ED
Credential:
Phone: 916-384-7544