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Organization
BOUCH MEDICAL CORPORATION
Active
Organization
BOUCH MEDICAL CORPORATION
Active
Other names
Hill Park Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
SUMMER BEGIN (PRACTICE MANAGER)
(707) 861-7300
Entity
Organization
Contact information
Practice address
435 PETALUMA AVE STE 150, SEBASTOPOL, CA 95472-4273
(707) 861-7300
(707) 823-8568
Mailing address
435 PETALUMA AVE STE 150, SEBASTOPOL, CA 95472-4273
(707) 861-7300
(707) 823-8568
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
393692
CA
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
20A9470
CA
207R00000X
Internal Medicine Physician
G55518
CA
208D00000X
General Practice Physician
Primary
G35969
CA
208D00000X
General Practice Physician
ND-353
CA
208D00000X
General Practice Physician
ND-613
CA
Other
Enumeration date
05/20/2015
Last updated
05/20/2015
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