MEDICARE: NORTH COUNTY TRAUMA SERVICES, INC.

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	2086S0127X	Trauma Surgery Physician	68721	CA

General Provider Information

NPI Number	:	1194819532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH COUNTY TRAUMA SERVICES, INC.

Provider Business Mailing Address
First Line	:	451 MARCH AVENUE
Second Line	:	SUITE B
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3387
Country	:	US
Telephone Number	:	707-433-8844
Fax Number	:	707-433-8836

Provider Business Practice Location Address
First Line	:	451 MARCH AVENUE
Second Line	:	SUITE B
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3387
Country	:	US
Telephone Number	:	707-433-8844
Fax Number	:	707-433-8836

Authorized Official
Title or Position	:	INCORPORATOR
Name	:	DR. HENRY CUEVAS FLORES
Credential	:	M.D.
Telephone Number	:	707-433-8844

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/22/2020

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