| El Rose Medical Group | |
|
24 West El Rose Ave Petaluma CA 94952 | |
| (707) 763-9891 | |
| (707) 763-9896 |
| Full Name | El Rose Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 24 West El Rose Ave, Petaluma, California |
| Authorized Official Name and Position | David A Sisler (OWNER) |
| Authorized Official Contact | 7077639491 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| El Rose Medical Group 24 West El Rose Ave Petaluma CA 94952 Ph: (707) 763-9891 | El Rose Medical Group 24 West El Rose Ave Petaluma CA 94952 Ph: (707) 763-9891 |
| NPI Number | 1902976236 |
|---|---|
| Provider Enumeration Date | 11/08/2006 |
| Last Update Date | 07/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902976236 | NPI | - | NPPES |
| C26495 | Other | STATE LICENSE # | |
| CP6140 | Other | RAILROAD MEDICARE | |
| ZZZ75987Z | Other | MEDI CAL | |
| AROSE0543 | Other | BLUE CROSS BLUE SHIELD | |
| C17753 | Other | STATE LICENSE # | |
| G21106 | Other | STATE LICENSE # | |
| ZZZ75987Z | Other | MEDI CAL GRP # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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