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
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 573-6161
(707) 573-6165
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 525-6485
(707) 573-6918
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0001730
—
CA
01
—
ZZZ53773Y
BS OF CALIFORNIA
CA
Enumeration date
09/11/2006
Last updated
03/20/2009
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