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Organization
REDWOOD PEDIATRIC MEDICAL GROUP
Active
Organization
REDWOOD PEDIATRIC MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHALAMAR IVEY (BILLING MANAGER)
(707) 725-9355
Entity
Organization
Contact information
Practice address
3305 RENNER DR, FORTUNA, CA 95540-3119
(707) 725-9355
(707) 725-2426
Mailing address
3305 RENNER DR, FORTUNA, CA 95540-3119
(707) 725-2426
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G082256
CA
Other
Enumeration date
01/18/2007
Last updated
08/22/2020
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