MEDICARE: SUTTER MEDICAL GROUP OF THE REDWOODS

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	207V00000X	Obstetrics & Gynecology Physician		CA
2	207Q00000X	Family Medicine Physician		CA

General Provider Information

NPI Number	:	1497842835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTER MEDICAL GROUP OF THE REDWOODS

Provider Business Mailing Address
First Line	:	3883 AIRWAY DR
Second Line	:	SUITE 300
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1670
Country	:	US
Telephone Number	:	707-521-8809
Fax Number	:	707-521-8835

Provider Business Practice Location Address
First Line	:	652 PETALUMA AVE
Second Line	:	SUITE F
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4256
Country	:	US
Telephone Number	:	707-823-2334
Fax Number	:	707-823-3007

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	LINDA E ROCKSTROH
Credential	:
Telephone Number	:	707-521-8809

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/21/2022

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