Organization
ENDOSCOPY CENTER OF SANTA ROSA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARION AULD RN (MANAGER)
(707) 571-2192
Entity
Organization
Contact information
Practice address
1200 SONOMA AVE, SUITE 2, SANTA ROSA, CA 95405-6664
(707) 571-2192
(707) 571-2194
Mailing address
1200 SONOMA AVE, SUITE 2, SANTA ROSA, CA 95405-6664
(707) 571-2192
(707) 571-2194
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AS1557
BLUE CROSS
CA
01
—
ZZZH49112
BLUE SHIELD
CA
Enumeration date
07/15/2006
Last updated
07/21/2022
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