Provider Demographics
NPI:1316439979
Name:WOMEN'S OBGYN
Entity type:Organization
Organization Name:WOMEN'S OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-575-1626
Mailing Address - Street 1:1111 SONOMA AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-575-1626
Mailing Address - Fax:707-575-3941
Practice Address - Street 1:1111 SONOMA AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-575-1626
Practice Address - Fax:707-575-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
CAG061698261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty