MEDICARE: DR. SABRINA ANN KIDD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A111326	CA
2	208C00000X	Colon & Rectal Surgery Physician	A111326	CA

General Provider Information

NPI Number	:	1053534354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SABRINA ANN KIDD M.D.

Provider Business Mailing Address
First Line	:	462 W NAPA ST
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6519
Country	:	US
Telephone Number	:	707-931-4219
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 MARK WEST SPRINGS RD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1436
Country	:	US
Telephone Number	:	707-576-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	06/10/2022

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