# VASCULAR LABORATORY OF SANTA ROSA, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821202003
- **Authorized official:** MR. ROBERT RICHARDSON M.D. (MANAGING DIRECTOR)
- **Authorized official phone:** (707) 545-2436

## Contact information

- **Practice address:** 1111 SONOMA AVE STE 322, SANTA ROSA, CA 95405-4820
- **Practice address phone:** (707) 576-1522
- **Practice address fax:** (707) 576-1523
- **Mailing address:** 1111 SONOMA AVE STE 322, SANTA ROSA, CA 95405-4820
- **Mailing address phone:** (707) 576-1522
- **Mailing address fax:** (707) 576-1523

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2471V0105X | Vascular Sonography Radiologic Technologist | C1090923 | CA | Yes |

## Other

- **Enumeration date:** 05/09/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0006300 | — | CA |