MEDICARE: REDWOOD UROLOGY MEDICAL GROUP

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1174549588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDWOOD UROLOGY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	500 DOYLE PARK DR STE 303
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4559
Country	:	US
Telephone Number	:	707-575-1833
Fax Number	:	707-575-3561

Provider Business Practice Location Address
First Line	:	500 DOYLE PARK DR STE 303
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4559
Country	:	US
Telephone Number	:	707-575-1833
Fax Number	:	707-575-3561

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. JAMES PALLESCHI
Credential	:	M.D.
Telephone Number	:	707-575-1833

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	08/22/2020

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Directions to “REDWOOD UROLOGY MEDICAL GROUP ” Practice Location

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