| Northern California Medical Assoc Inc | |
|
104 Lynch Creek Way Ste 10 Petaluma CA 94954-2355 | |
| (707) 782-9123 | |
| (707) 782-9622 |
| Full Name | Northern California Medical Assoc Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 104 Lynch Creek Way, Petaluma, California |
| Authorized Official Name and Position | Ruth A Skidmore (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7075736925 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern California Medical Assoc Inc 3536 Mendocino Ave Ste 200 Santa Rosa CA 95403-3634 Ph: (707) 525-6485 | Northern California Medical Assoc Inc 104 Lynch Creek Way Ste 10 Petaluma CA 94954-2355 Ph: (707) 782-9123 |
| NPI Number | 1245411529 |
|---|---|
| Provider Enumeration Date | 11/15/2007 |
| Last Update Date | 10/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245411529 | NPI | - | NPPES |
| ZZZ51563Y | Other | CA | BLUE SHIELD |
| 1245411529 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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