Organization · Type 2 NPI

Department of Health Services

Clinic/Center · Santa Rosa, CA

NPI number 1114071453 Active

Practice location

155 N. Pythian Road
Santa Rosa, CA 95409

Call (707) 565-6350 Map

Mailing address

PO Box 1539
Santa Rosa, CA 95402-1539

Specialties and licenses

TaxonomyCodeLicense
Clinic/Center Primary 261Q00000XNone listed

Clinic/Center: A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

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About NPI 1114071453

Department of Health Services's National Provider Identifier is 1114071453, issued on Jan 23, 2007. The primary taxonomy on file is Clinic/Center (261Q00000X), and the practice location is in Santa Rosa, CA. The record was last updated on Dec 18, 2007.