Organization
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY A DEWALD (DIRECTOR OF BUSINESS SVCS)
(707) 525-6485
Entity
Organization
Contact information
Practice address
4625 QUIGG DR, SANTA ROSA, CA 95409-5377
(707) 537-2111
(707) 537-2119
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
208600000X
Surgery Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
09/18/2018
Last updated
12/14/2020
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