| NPI | 1265015978 |
|---|---|
| Other Name | PROVIDENCE MEDICAL GROUP NORTHERN CALIFORNIA |
| Entity Type | Organization |
| Authorized Contact | BOB JUST Chief Executive 707-303-8355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2022-07-12 |