Provider Demographics
NPI:1265455448
Name:MCAULIFFE, NAOMI A (DO)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:A
Last Name:MCAULIFFE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 DOYLE PARK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4570
Mailing Address - Country:US
Mailing Address - Phone:707-526-1800
Mailing Address - Fax:707-526-9352
Practice Address - Street 1:510 DOYLE PARK DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4570
Practice Address - Country:US
Practice Address - Phone:707-526-1800
Practice Address - Fax:707-526-9352
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA129605207Q00000X
CA20A8315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81459076Medicaid
NM344516107Medicare ID - Type Unspecified
I30320Medicare UPIN
CAAZ182XMedicare PIN