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
95 MONTGOMERY DR, STE 120, SANTA ROSA, CA 95404-6617
(707) 578-7530
(707) 578-7533
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 578-7530
(707) 578-7533
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN8040
RAILROAD MEDICARE
CA
01
—
ZZZ67989Y
BLUE SHIELD
CA
Enumeration date
07/28/2011
Last updated
02/09/2012
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