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2285 Olivet Ln Santa Rosa CA 95401-3860 | |
| (707) 280-4039 | |
| (707) 526-0465 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 2285 Olivet Ln, Santa Rosa, California |
| Authorized Official Name and Position | Shelleen E Denno (PRESIDENT) |
| Authorized Official Contact | 7072804039 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2285 Olivet Ln Santa Rosa CA 95401-3860 Ph: (707) 280-4039 | 2285 Olivet Ln Santa Rosa CA 95401-3860 Ph: (707) 280-4039 |
| NPI Number | 1457613275 |
|---|---|
| Provider Enumeration Date | 06/08/2012 |
| Last Update Date | 06/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457613275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A50098 (California) | Primary |
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