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General NPI Number Information
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NPI Number | 1841204518
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Entity Type | Organization
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Legal Business Name | REDWOOD REGIONAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 110 LYNCH CREEK WAY STE A
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City | PETALUMA
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State | CA
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Zip | 94954-2337
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Country | US
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Telephone | 707-763-0600
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Fax | 707-765-1757
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Provider Business Mailing Address
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Address Line | 110 LYNCH CREEK WAY STE A
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City | PETALUMA
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State | CA
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Zip | 94954-2337
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Country | US
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Telephone | 707-763-0600
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Fax | 707-765-1757
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Authorized Official
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Title or Position | PRESIDENT
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Name | HELEN COLLINS
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Credential | M.D.
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Telephone | 707-546-4602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology 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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 05D0689028
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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