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Organization

NORTHERN CALIFORNIA MEDICAL ASSOC INC

Active
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Organization

NORTHERN CALIFORNIA MEDICAL ASSOC INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. RUTH ANN SKIDMORE (CHIEF EXECUTIVE OFFICER)
(707) 573-6925
Entity
Organization

Contact information

Practice address
3536 MENDOCINO AVE, STE 300, SANTA ROSA, CA 95403
(707) 573-6942
(707) 575-6038
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 575-6049
(707) 575-6038

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RR0500X
Rheumatology Physician
—
—

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR000173F
—
CA
01
—
ZZZ29088Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/07/2005
Last updated
08/07/2018
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