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SANTA ROSA SPORTS MEDICINE INCORPORATED NPI 1952555740


NPI Information

NPI: 1952555740
Provider Name: SANTA ROSA SPORTS MEDICINE, INCORPORATED

Other Name: SANTA ROSA SPORTS AND FAMILY MEDICINE

Classification: Family Medicine - 207QS0010X
Entity Type: Organization

Specialization: Sports Medicine

Address:
1255 N DUTTON AVE
SANTA ROSA, CA
ZIP 95401
Phone: (707) 546-9400
Get Directions

SANTA ROSA SPORTS MEDICINE, INCORPORATED is a sports medicine family medicine in Santa Rosa, CA. The provider is a family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. SANTA ROSA SPORTS MEDICINE, INCORPORATED NPI is 1952555740. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Santa Rosa Sports And Family Medicine.

The provider's business location address is:

1255 N DUTTON AVE
SANTA ROSA, CA
ZIP 95401-663
Phone: (707) 546-9400
Fax: (707) 546-9464

The provider's authorized official is Ty Preston Affleck .
The authorized official title is President and has the following contact phone number (707) 546-9400.

The enumeration date for this NPI number is 11/6/2008 and was last updated on 10/13/2014.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207QS0010XFamily MedicineSports MedicineG073843CALIFORNIAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1BG316MEDICARE PINCALIFORNIA

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

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