Organization
REDWOOD RADIOLOGY GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK E MODIC M.D. (PRESIDENT)
(707) 546-4062
Entity
Organization
Contact information
Practice address
121 SOTOYOME ST, SANTA ROSA, CA 95405-4823
(707) 546-4062
(707) 525-4095
Mailing address
PO BOX 5651, ORANGE, CA 92863-5651
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ81615Y
BLUE SHIELD
CA
01
—
ZZZ81617Y
BLUE SHIELD
CA
01
—
ZZZ81618Y
BLUE SHIELD
CA
01
—
ZZZ81619Y
BLUE SHIELD
CA
01
—
ZZZ81620Y
BLUE SHIELD
CA
Enumeration date
01/21/2014
Last updated
12/23/2020
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