# NORTHERN CALIFORNIA MEDICAL ASSOC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northern California Medical Associates, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588220636
- **Authorized official:** SALLY A DEWALD (BUSINESS SERVICES MANAGER)
- **Authorized official phone:** (707) 525-6485

## Contact information

- **Practice address:** 1116 B ST, PETALUMA, CA 94952-4054
- **Practice address phone:** (707) 782-9123
- **Practice address fax:** (707) 782-9622
- **Mailing address:** 3536 MENDOCINO AVE STE 200, SANTA ROSA, CA 95403-3634
- **Mailing address phone:** (707) 782-9123
- **Mailing address fax:** (707) 782-9622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/14/2019
- **Last updated:** 05/14/2019