| Women's Obgyn | |
|
1111 Sonoma Avenue Suite 202 Santa Rosa CA 95405 | |
| (707) 575-1626 | |
| (707) 575-3941 |
| Full Name | Women's Obgyn |
|---|---|
| Speciality | Obstetrics & Gynecology |
| Location | 1111 Sonoma Avenue, Santa Rosa, California |
| Authorized Official Name and Position | Lela M. Emad (PRESIDENT) |
| Authorized Official Contact | 7075751626 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Women's Obgyn 1111 Sonoma Avenue Suite 202 Santa Rosa CA 95405 Ph: (707) 575-1626 | Women's Obgyn 1111 Sonoma Avenue Suite 202 Santa Rosa CA 95405 Ph: (707) 575-1626 |
| NPI Number | 1316439979 |
|---|---|
| Provider Enumeration Date | 05/30/2018 |
| Last Update Date | 02/01/2019 |
| Medicare PECOS PAC ID | 4789929506 |
|---|---|
| Medicare Enrollment ID | O20181226001946 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316439979 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | G061698 (California) | Secondary |
| 207V00000X | Obstetrics & Gynecology | (* (Not Available)) | Primary |
| Provider Name | Susan Logan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1982716221 PECOS PAC ID: 8921071309 Enrollment ID: I20081226000063 |
| Provider Name | Lela M Emad |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1811902612 PECOS PAC ID: 2567435944 Enrollment ID: I20090126000391 |
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