Organization
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RUTH A SKIMORE (CHIEF EXECUTIVE OFFICER)
(707) 573-6925
Entity
Organization
Contact information
Practice address
1140 SONOMA AVE, STE 1A, SANTA ROSA, CA 95405-4817
(707) 546-5553
(707) 546-0725
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
208800000X
Urology Physician
Primary
—
—
2088P0231X
Pediatric Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588829691
—
CA
01
—
ZZZ54233Y
BS OF CALIFORNIA
CA
Enumeration date
07/29/2008
Last updated
12/09/2008
Update your record
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