PROVIDENCE MEDICAL FOUNDATION NPI 1265015978

NPI Information

  • NPI: 1265015978
  • Provider Name: PROVIDENCE MEDICAL FOUNDATION
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Other Name: PROVIDENCE MEDICAL GROUP NORTHERN CALIFORNIA
  • Address: 185 SOTOYOME ST
    SANTA ROSA, CA
    ZIP 95405
  • Phone: (707) 303-8355

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NPI Details

PROVIDENCE MEDICAL FOUNDATION is a family medicine in Santa Rosa, CA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PROVIDENCE MEDICAL FOUNDATION NPI is 1265015978. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Providence Medical Group Northern California.

The provider's business location address is:

185 SOTOYOME ST
SANTA ROSA, CA
ZIP 95405-803
Phone: (707) 303-8355
Fax: (707) 303-2035

The provider's authorized official is Bob Just .
The authorized official title is Chief Executive and has the following contact phone number (707) 303-8355.

The enumeration date for this NPI number is 4/30/2021 and was last updated on 7/12/2022.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

What is NPI?

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This page was last updated on: 11/21/2025

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