Healthcare Provider Details

I. General information

NPI: 1891705257
Provider Name (Legal Business Name): REDWOOD REGIONAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 ROUND BARN CIR STE 100
SANTA ROSA CA
95403-1757
US

IV. Provider business mailing address

3555 ROUND BARN CIR STE 100
SANTA ROSA CA
95403-1757
US

V. Phone/Fax

Practice location:
  • Phone: 707-528-1050
  • Fax: 707-525-3874
Mailing address:
  • Phone: 707-528-1050
  • Fax: 707-525-3874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0612494
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: HELEN COLLINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-546-4062