EL ROSE MEDICAL GROUP NPI 1902976236

NPI Information

NPI: 1902976236
Provider Name: EL ROSE MEDICAL GROUP
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
24 WEST EL ROSE AVE
PETALUMA, CA
ZIP 94952
Phone: (707) 763-9891
Get Directions

EL ROSE MEDICAL GROUP is a family medicine in Petaluma, 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. EL ROSE MEDICAL GROUP NPI is 1902976236. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

24 WEST EL ROSE AVE
PETALUMA, CA
ZIP 94952
Phone: (707) 763-9891
Fax: (707) 763-9896

The provider's authorized official is David A Sisler .
The authorized official title is Owner and has the following contact phone number (707) 763-9491.

The enumeration date for this NPI number is 11/8/2006 and was last updated on 7/8/2008.

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
1	207Q00000X	Family Medicine				Yes

Other Identifiers

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

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier Issuer
1	ZZZ75987Z	MEDICARE ID-TYPE UNSPECIFIED	IND #
2	=========	OTHER	TAX ID#
3	AROSE0543	OTHER	BLUE CROSS BLUE SHIELD
4	C17753	OTHER	STATE LICENSE #
5	CP6140	OTHER	RAILROAD MEDICARE
6	ZZZ75987Z	OTHER	MEDI CAL GRP #
7	A31088	MEDICARE UPIN
8	ZZZ75987Z	MEDICARE ID-TYPE UNSPECIFIED	GRP #
9	ZZZ75987Z	OTHER	MEDI CAL
10	A41180	MEDICARE UPIN
11	G21106	OTHER	STATE LICENSE #
12	A33142	MEDICARE UPIN
13	C26495	OTHER	STATE LICENSE #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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