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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
MS. RUTH ANN SKIDMORE (CHIEF EXECUTIVE OFFICER)
(707) 573-6925
Entity
Organization
Contact information
Practice address
45081 LITTLE LAKE ST, MENDOCINO, CA 95460
(707) 573-6166
(707) 573-6165
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 525-6485
(707) 573-6918
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0001736
—
CA
01
—
ZZZ01805Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/18/2005
Last updated
02/09/2012
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