Provider Demographics
NPI:1154523447
Name:SANTA ROSA CARDIAC IMAGING
Entity type:Organization
Organization Name:SANTA ROSA CARDIAC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-527-5155
Mailing Address - Street 1:500 DOYLE PARK DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4558
Mailing Address - Country:US
Mailing Address - Phone:707-527-8444
Mailing Address - Fax:707-527-1071
Practice Address - Street 1:1111 SONOMA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4819
Practice Address - Country:US
Practice Address - Phone:707-636-0190
Practice Address - Fax:707-636-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21454ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER