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
1370 MEDICAL CENTER DR, STE A, ROHNERT PARK, CA 94928-2934
(707) 585-6110
(707) 585-6145
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 525-6485
(707) 573-6918
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN8040
RAILROAD MEDICARE
CA
01
—
ZZZ69577Y
BLUE SHIELD
CA
Enumeration date
12/13/2011
Last updated
03/22/2012
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