# NORTHERN CALIFORNIA MEDICAL ASSOC INC

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

## Provider details

- **NPI number:** 1871008318
- **Authorized official:** SALLY A DEWALD (DIRECTOR OF BUSINESS SERVICES)
- **Authorized official phone:** (707) 525-6485

## Contact information

- **Practice address:** 1701 4TH ST STE 210, SANTA ROSA, CA 95404-3661
- **Practice address phone:** (707) 578-7530
- **Practice address fax:** (707) 578-7533
- **Mailing address:** 3536 MENDOCINO AVE STE 200, SANTA ROSA, CA 95403-3634
- **Mailing address phone:** (707) 525-6485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133V00000X | Registered Dietitian | — | NULL | — |
| 133V00000X | Registered Dietitian | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2017
- **Last updated:** 10/05/2018