| Dutton Campus | |
|
1300 N Dutton Ave Santa Rosa CA 95401-7112 | |
| (707) 303-3600 | |
| Not Available |
| Full Name | Dutton Campus |
|---|---|
| Speciality | Clinic/Center |
| Location | 1300 N Dutton Ave, Santa Rosa, California |
| Authorized Official Name and Position | Gabriela Bernal-leroi (DIRECTOR OF REVENUE CYCLE) |
| Authorized Official Contact | 7073033600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dutton Campus 3569 Round Barn Cir Santa Rosa CA 95403-5781 Ph: (707) 303-3600 | Dutton Campus 1300 N Dutton Ave Santa Rosa CA 95401-7112 Ph: (707) 303-3600 |
| NPI Number | 1780195255 |
|---|---|
| Provider Enumeration Date | 10/23/2017 |
| Last Update Date | 12/09/2022 |
| Certification Date | 12/09/2022 |
| Medicare PECOS PAC ID | 0345130423 |
|---|---|
| Medicare Enrollment ID | O20180411002373 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780195255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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