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General NPI Number Information
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NPI Number | 1407970544
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Entity Type | Organization
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Legal Business Name | SUTTER MEDICAL GROUP OF THE REDWOODS
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1200 SONOMA AVE SUITE 6
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City | SANTA ROSA
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State | CA
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Zip | 95405-6664
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Country | US
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Telephone | 707-545-2545
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Fax | 707-545-1829
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Provider Business Mailing Address
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Address Line | 3883 AIRWAY DR SANTA ROSA
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City | SANTA ROSA
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State | CA
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Zip | 95403-1670
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Country | US
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Telephone | 707-521-8809
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Fax | 707-521-8835
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | LINDA E ROCKSTROH
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Credential |
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Telephone | 707-521-8809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | CA
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