Organization
DEPARTMENT OF HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA L STORNETTA (ACCOUNTANT III COMPLIANCE)
(707) 565-4782
Entity
Organization
Contact information
Practice address
2665A DUTTON MDW, SANTA ROSA, CA 95407-7730
(707) 565-4518
Mailing address
2665A DUTTON MDW, SANTA ROSA, CA 95407-7730
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
01/18/2007
Last updated
08/22/2020
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