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General NPI Number Information
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NPI Number | 1083802979
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Entity Type | Organization
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Legal Business Name | TRADITIONS PSYCHIATRY GROUP, P.C
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 1287 FULTON RD
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City | SANTA ROSA
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State | CA
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Zip | 95401-4923
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Country | US
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Telephone | 707-258-8757
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Fax | 707-253-0457
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Provider Business Mailing Address
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Address Line | 900 LARKSPUR LANDING CIR STE 160
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City | LARKSPUR
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State | CA
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Zip | 94939-1766
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Country | US
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Telephone | 707-258-8757
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Fax | 707-253-0457
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Authorized Official
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Title or Position | CFO
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Name | JULIANNE BHARUCHA
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Credential |
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Telephone | 775-762-3679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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