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
719 SOUTHPOINT BLVD, STE B, PETALUMA, CA 94954-1495
(707) 778-8421
(707) 778-1702
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
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0001735
—
CA
01
—
ZZZ37618Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/18/2005
Last updated
02/09/2012
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