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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
SALLY A DEWALD (DIRECTOR OF BUSINESS SERVICES)
(707) 525-6485
Entity
Organization
Contact information
Practice address
1701 4TH ST STE 210, SANTA ROSA, CA 95404-3661
(707) 578-7530
(707) 578-7533
Mailing address
3536 MENDOCINO AVE STE 200, SANTA ROSA, CA 95403-3634
(707) 525-6485
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
NULL
133V00000X
Registered Dietitian
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Enumeration date
12/06/2017
Last updated
10/05/2018
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