Organization
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RUTH A SKIDMORE (CHIEF EXECUTIVE OFFICER)
(707) 573-6125
Entity
Organization
Contact information
Practice address
1383 N MCDOWELL BLVD, STE 100, PETALUMA, CA 94954-1190
(707) 763-6400
(707) 763-6266
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
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124467006
—
CA
Enumeration date
06/24/2013
Last updated
05/05/2015
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