Organization
ALLERGY & ASTHMA ADULT & PEDIATRIC MEDICAL GROUP OF THE REDWOODS INC
Active
Other names
FamilyCare Allergy and Asthma
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN F PETRICK BA DEGREE (CEO)
(707) 525-0211
Entity
Organization
Contact information
Practice address
130 STONY POINT RD, SUITE E, SANTA ROSA, CA 95401-4120
(707) 525-0211
(707) 525-0491
Mailing address
130 STONY POINT RD, SUITE E, SANTA ROSA, CA 95401-4120
(707) 525-0211
(707) 525-0491
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
C132754
CA
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
G29076
CA
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
G33461
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0061440
—
CA
01
—
HKRAA3F00
HIN NUMBER
—
01
—
ZZZ95243Z
MEDICARE PTAN
CA
Enumeration date
12/04/2006
Last updated
11/16/2015
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