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
506 S MAIN ST, SEBASTOPOL, CA 95472-4261
(707) 829-5455
(707) 824-9235
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
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
20A5942
CA
207Q00000X
Family Medicine Physician
20A5942
CA
Other
Enumeration date
11/22/2017
Last updated
11/22/2017
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