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General NPI Number Information
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NPI Number | 1457534174
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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 | 12/17/2007
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 1701 4TH ST STE 200
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City | SANTA ROSA
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State | CA
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Zip | 95404-3601
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Country | US
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Telephone | 707-579-2100
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Fax | 707-523-0616
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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 | 707-523-0616
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. RUTH A 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 | 2086S0127X
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Taxonomy Name | Trauma Surgery 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 | 2086S0129X
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Taxonomy Name | Vascular Surgery 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 | 207W00000X
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Taxonomy Name | Ophthalmology 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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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