Organization
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RUTH A SKIDMORE (CHIEF EXECUTIVE OFFICER)
(707) 573-6925
Entity
Organization
Contact information
Practice address
1701 4TH ST, STE 200, SANTA ROSA, CA 95404-3601
(707) 579-2100
(707) 523-0616
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 525-6485
(707) 523-0616
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0127X
Trauma Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457534174
—
CA
01
—
ZZZ51552Y
BLUE SHIELD
CA
Enumeration date
12/17/2007
Last updated
02/09/2012
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