Provider Demographics
NPI:1558421701
Name:REDWOOD WOMEN'S HEALTH CENTER
Entity Type:Organization
Organization Name:REDWOOD WOMEN'S HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-725-6108
Mailing Address - Street 1:3307 RENNER DR
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-3119
Mailing Address - Country:US
Mailing Address - Phone:707-725-6108
Mailing Address - Fax:707-725-2651
Practice Address - Street 1:3307 RENNER DR
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-3119
Practice Address - Country:US
Practice Address - Phone:707-725-6108
Practice Address - Fax:707-725-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1681176B00000X
CA1639176B00000X
CA00A25979207V00000X
CAA75325207V00000X
CAA77441207V00000X
CAG79397208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087580Medicaid
CAZZZ00521ZOtherBLUE SHIELD
CAZZZ00521ZOtherBLUE SHIELD
CA=========OtherBLUE CROSS