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Organization
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Active
Organization
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RUTH SKIDMORE (CHEIF EXECUTIVE OFFICER)
(707) 573-6933
Entity
Organization
Contact information
Practice address
4761 HOEN AVE, SANTA ROSA, CA 95405-7862
(707) 545-0570
(707) 545-0575
Mailing address
3536 MENDOCINO AVE, 200, SANTA ROSA, CA 95403-3634
(707) 575-6049
(707) 545-0575
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN8040
RAILROAD MEDICARE
CA
01
—
ZZZ38300Z
BLUE SHIELD
CA
Enumeration date
09/26/2011
Last updated
03/01/2012
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