MEDICARE: MOBILITY MASTERS NORTHERN CALIFORNIA 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	332B00000X	Durable Medical Equipment & Medical Supplies	103424	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	089322152002	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1265539217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILITY MASTERS NORTHERN CALIFORNIA INC.

Provider Business Mailing Address
First Line	:	1575 FARMERS LANE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-7525
Country	:	US
Telephone Number	:	707-525-1994
Fax Number	:	707-525-1920

Provider Business Practice Location Address
First Line	:	1575 FARMERS LANE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-7525
Country	:	US
Telephone Number	:	707-525-1994
Fax Number	:	707-525-1920

Authorized Official
Title or Position	:	CEO
Name	:	RENATE SUSAN TIPSWORD
Credential	:
Telephone Number	:	707-525-1994

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/29/2014

Similar Medicare Providers

1144224791 — DR. IAN JAMES MIDDLETON OD
Practice Location Address:

1559 FARMERS LN
SANTA ROSA, CA
95405-7525

Practice Phone: 707-571-2020
Practice Fax: 707-540-6299

1548282650 — THRIFTY PAYLESS INC
Practice Location Address:

1551 FARMERS LANE , FARMERS LANE PLAZA
SANTA ROSA, CA
95405-7525

Practice Phone: 707-544-4050
Practice Fax:

1326159658 — CHRISTOPHER JAMES FEAHR O.D.
Practice Location Address:

1559 FARMERS LN
SANTA ROSA, CA
95405-7525

Practice Phone: 707-571-2020
Practice Fax:

1407070170 — MR. PETER DICKASON
Practice Location Address:

1551 FARMERS LN
SANTA ROSA, CA
95405-7525

Practice Phone: 707-544-4050
Practice Fax: 707-544-6147

1518288182 — DAISY VILLASENIOR UMALI
Practice Location Address:

1551 FARMERS LN
SANTA ROSA, CA
95405-7525

Practice Phone: 707-544-4050
Practice Fax:

1245577246 — DAVE GARDNER
Practice Location Address:

1517 FARMERS LN
SANTA ROSA, CA
95405-7525

Practice Phone: 707-959-4333
Practice Fax: 707-595-4350

Directions to “MOBILITY MASTERS NORTHERN CALIFORNIA INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.