Organization
BOUCH MEDICAL CORPORATION
Active
Other names
Hill Park Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
SUMMER BEGIN (PRACTICE MANAGER)
(707) 861-7300
Entity
Organization
Contact information
Practice address
435 PETALUMA AVE STE 150, SEBASTOPOL, CA 95472-4273
(707) 861-7300
(707) 823-8568
Mailing address
435 PETALUMA AVE STE 150, SEBASTOPOL, CA 95472-4273
(707) 861-7300
(707) 823-8568
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
393692
CA
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
20A9470
CA
207R00000X
Internal Medicine Physician
G55518
CA
208D00000X
General Practice Physician
Primary
G35969
CA
208D00000X
General Practice Physician
ND-353
CA
208D00000X
General Practice Physician
ND-613
CA
Other
Enumeration date
05/20/2015
Last updated
05/20/2015
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