# NORTHERN CALIFORNIA MEDICAL ASSOC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093229312
- **Authorized official:** SALLY A DEWALD (DIRECTOR OF BUSINESS SERVICES)
- **Authorized official phone:** (707) 525-6485

## Contact information

- **Practice address:** 506 S MAIN ST, SEBASTOPOL, CA 95472-4261
- **Practice address phone:** (707) 829-5455
- **Practice address fax:** (707) 824-9235
- **Mailing address:** 3536 MENDOCINO AVE STE 200, SANTA ROSA, CA 95403-3634
- **Mailing address phone:** (707) 525-6485
- **Mailing address fax:** (707) 573-6918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 20A5942 | CA | Yes |
| 207Q00000X | Family Medicine Physician | 20A5942 | CA | — |

## Other

- **Enumeration date:** 11/22/2017
- **Last updated:** 11/22/2017