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General NPI Number Information
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NPI Number | 1760833834
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Entity Type | Organization
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Legal Business Name | SUTTER BAY MEDICAL FOUNDATION
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 750 LAS GALLINAS AVE STE 210
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3432
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Country | US
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Telephone | 415-479-7244
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Fax | 415-479-0917
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Provider Business Mailing Address
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Address Line | PO BOX 276950
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City | SACRAMENTO
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State | CA
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Zip | 95827-6950
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SH VP, QUALITY, SAFETY, PATIENT ED
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Name | KRISTA LOPES
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Credential |
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Telephone | 916-384-7544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 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 #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology 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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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