Provider Demographics
NPI:1699940007
Name:NAPA VALLEY WOMEN'S HEALTHCARE-AMERICAN CANYON
Entity type:Organization
Organization Name:NAPA VALLEY WOMEN'S HEALTHCARE-AMERICAN CANYON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:R.
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:SCARBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-251-1850
Mailing Address - Street 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE #209
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2900
Mailing Address - Country:US
Mailing Address - Phone:707-251-1850
Mailing Address - Fax:707-251-1860
Practice Address - Street 1:3431 BROADWAY ST # 29
Practice Address - Street 2:SUITE A/8
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1228
Practice Address - Country:US
Practice Address - Phone:707-553-1004
Practice Address - Fax:707-552-2318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAPA VALLEY WOMEN'S HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000060207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03377ZMedicare PIN