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General NPI Number Information
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NPI Number | 1376540518
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Entity Type | Organization
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Legal Business Name | NORTHERN CALIFORNIA MEDICAL ASSOC INC
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 3536 MENDOCINO AVE STE 200
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City | SANTA ROSA
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State | CA
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Zip | 95403-3634
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Country | US
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Telephone | 707-573-6166
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Fax | 707-573-6165
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Provider Business Mailing Address
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Address Line | 3536 MENDOCINO AVE STE 200
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City | SANTA ROSA
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State | CA
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Zip | 95403-3634
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Country | US
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Telephone | 707-525-6485
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Fax | 707-573-6918
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. RUTH ANN SKIDMORE
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Credential |
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Telephone | 707-573-6925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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