MEDICARE: SUTTER BAY MEDICAL FOUNDATION

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1093269235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTER BAY MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 276950
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-6950
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3883 AIRWAY DR
Second Line	:	SUITE 202
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1670
Country	:	US
Telephone Number	:	707-521-8900
Fax Number	:	707-523-1302

Authorized Official
Title or Position	:	SR. DIRECTOR, PLANNING AND ALIGNMEN
Name	:	KRISTIN KELLER
Credential	:
Telephone Number	:	650-934-7000

Provider Enumeration Date	:	08/04/2016
Last Update Date	:	03/18/2026

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Directions to “SUTTER BAY MEDICAL FOUNDATION ” Practice Location

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