Organization
VASCULAR LABORATORY OF SANTA ROSA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT RICHARDSON M.D. (MANAGING DIRECTOR)
(707) 545-2436
Entity
Organization
Contact information
Practice address
1111 SONOMA AVE STE 322, SANTA ROSA, CA 95405-4820
(707) 576-1522
(707) 576-1523
Mailing address
1111 SONOMA AVE STE 322, SANTA ROSA, CA 95405-4820
(707) 576-1522
(707) 576-1523
Taxonomy
Speciality
Code
Description
License number
State
2471V0105X
Vascular Sonography Radiologic Technologist
Primary
C1090923
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0006300
—
CA
Enumeration date
05/09/2007
Last updated
08/22/2020
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