Individual
CHARLES A AMEZCUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 BICENTENNIAL WAY, SANTA ROSA, CA 95403-2149
(707) 571-4686
Mailing address
2800 SAINT PAUL DR, APT. 241, SANTA ROSA, CA 95405-8542
(707) 528-1980
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
G81183
CA
Other
Enumeration date
02/14/2007
Last updated
02/11/2022
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