# R. MITCHELL HISEROTE DO, PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blue Sky Osteopathy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548722416
- **Authorized official:** DR. RAYMOND MITCHELL HISEROTE DO (PHYSICIAN OWNER)
- **Authorized official phone:** (707) 329-6582

## Contact information

- **Practice address:** 7064 CORLINE CT STE C1, SEBASTOPOL, CA 95472-4528
- **Practice address phone:** (707) 329-6582
- **Mailing address:** 648 MCGINNIS CIR, COTATI, CA 94931-7718
- **Mailing address phone:** (559) 999-8647
- **Mailing address fax:** (707) 329-6372

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | NULL | Yes |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/01/2019
- **Last updated:** 02/24/2021