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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 A SKIDMORE (CHIEF EXECUTIVE OFFICER)
(707) 573-6925
Entity
Organization
Contact information
Practice address
104 LYNCH CREEK WAY, STE 10, PETALUMA, CA 94954-2355
(707) 782-9123
(707) 782-9622
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 525-6485
(707) 573-6918
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245411529
—
CA
01
—
ZZZ51563Y
BLUE SHIELD
CA
Enumeration date
11/15/2007
Last updated
10/16/2008
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