Organization
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RUTH ANN SKIDMORE (CHIEF EXECUTIVE OFFICER)
(707) 573-6925
Entity
Organization
Contact information
Practice address
721 RIVER DR, STE A, FORT BRAGG, CA 95437-5402
(707) 573-6166
(707) 573-6165
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 525-6049
(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
—
GR000173A
—
CA
01
—
ZZZ01804Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/07/2005
Last updated
02/09/2012
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