Organization
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RUTH A SKIDMORE (CHIEF EXECUTIVE OFFICER)
(707) 525-6925
Entity
Organization
Contact information
Practice address
1701 4TH ST, STE 120, SANTA ROSA, CA 95404-3661
(707) 523-7025
(707) 523-3024
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 575-6049
(707) 523-3024
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YS0123X
Facial Plastic Surgery Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
231H00000X
Audiologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396040226
—
CA
01
—
CN8040
RAILROAD MEDICARE
CA
01
—
ZZZ38629Z
BLUE SHIELD
CA
Enumeration date
01/25/2011
Last updated
11/05/2018
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