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711 Stony Point Rd Ste 17 Santa Rosa CA 95407-6848 | |
| (707) 578-2005 | |
| (707) 578-8037 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 711 Stony Point Rd Ste 17, 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 | 711 Stony Point Rd Ste 17 Santa Rosa CA 95407-6848 Ph: (707) 578-2005 |
| NPI Number | 1558512624 |
|---|---|
| Provider Enumeration Date | 10/07/2008 |
| Last Update Date | 11/15/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558512624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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