Provider Demographics
NPI:1881839520
Name:NORCAL SKIN DISEASE AND SURGERY INC
Entity Type:Organization
Organization Name:NORCAL SKIN DISEASE AND SURGERY INC
Other - Org Name:NORCAL DERMATOLOGY MEDICAL SURGICAL COSMETIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROPHY
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM, CMA
Authorized Official - Phone:707-527-9517
Mailing Address - Street 1:196 WIKIUP DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7773
Mailing Address - Country:US
Mailing Address - Phone:707-527-9517
Mailing Address - Fax:707-527-9913
Practice Address - Street 1:196 WIKIUP DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-7773
Practice Address - Country:US
Practice Address - Phone:707-527-9517
Practice Address - Fax:707-527-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55665261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty