SANTA ROSA AMBULATORY SURGICAL CENTER MEDICAL GROUP INC NPI 1215002852

NPI Information

SANTA ROSA AMBULATORY SURGICAL CENTER MEDICAL GROUP INC is an ambulatory surgical clinic center in Santa Rosa, CA. SANTA ROSA AMBULATORY SURGICAL CENTER MEDICAL GROUP INC NPI is 1215002852. The provider is registered as an organization entity type.

The provider's business location address is:

76 BROOKWOOD AVE STE B
SANTA ROSA, CA
ZIP 95404-312
Phone: (707) 523-4907
Fax: (707) 523-4953

The provider's authorized official is Sophie Pappas .
The authorized official title is Cfo and has the following contact phone number (707) 523-4907.

The CLIA number assigned to this NPI record is 05D1029802 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/21/2006 and was last updated on 7/17/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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