Organization
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY A DEWALD (DIRECTOR OF BUSINESS SVCS)
(707) 525-6485
Entity
Organization
Contact information
Practice address
558 3RD ST W, SONOMA, CA 95476-6502
(707) 931-6469
(707) 934-8492
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
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548262926
—
CA
01
—
ZZZ38796Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
08/15/2005
Last updated
10/05/2018
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