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751 Lombardi Court Santa Rosa CA 95407-6793 | |
| (707) 547-2222 | |
| (707) 527-0472 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 751 Lombardi Court, Santa Rosa, California |
| Authorized Official Name and Position | Harold Brockman (CFO) |
| Authorized Official Contact | 7075838839 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3569 Round Barn Circle Santa Rosa CA 95403-5781 Ph: (707) 303-3600 | 751 Lombardi Court Santa Rosa CA 95407-6793 Ph: (707) 547-2222 |
| NPI Number | 1114120623 |
|---|---|
| Provider Enumeration Date | 06/11/2007 |
| Last Update Date | 11/19/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114120623 | NPI | - | NPPES |
| EAP70663F | Other | CA | EAPC ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 110000300 (California) | Primary |
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