ENTEGRATIVE OTOLARYNGOLOGY PC (NPI# 1417294174) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417294174 |
| Entity Type | Organization |
| Organization Name | ENTEGRATIVE OTOLARYNGOLOGY PC |
| Practice Address |
1144 Sonoma Ave Ste 101 Santa Rosa CA 95405-4812 |
| Practice Telephone | 7077750775 |
| Mailing Telephone | 7077750775 |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2013-01-14 |
| Authorized Official Name | LARRY KYLE GAMBRELL (DIRECTOR/CEO) |
| Authorized Official Telephone | 2674564848 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0905X |
Otolaryngology Specialization: Otolaryngology/Facial Plastic Surgery |
C3527438 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
1144 SONOMA AVE STE 101 |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95405-4812 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083230486 | Lizett Camacho | Counselor | 145o Neotomas Avenue Suite 200, Santa Rosa, CA 95405 | 2020-06-22 |
| 1346768918 | Ingrid Tsong | Student in an Organized Health Care Education/Training Program | 3447 Summerfield Road, Santa Rosa, CA 95405 | 2017-09-05 |
| 1275051898 | Jessica Peters Malmberg | Student in an Organized Health Care Education/Training Program | 2447 Summerfield Rd, Santa Rosa, CA 95405 | 2017-09-04 |
| 1306246772 | Kirsten Eckert | Advanced Practice Midwife | 500 Doyle Park Dr Suite 103, Santa Rosa, CA 95405 | 2014-09-03 |
| 1982034294 | Mohammad Reza Saeidi | Dentist | 1820 Sonoma Ave Ste 90a, Santa Rosa, CA 95405 | 2013-11-22 |
| 1851631642 | Debi M. Emmons | Marriage & Family Therapist | 2447 Summerfield Dr, Social Advocates for Youth, Santa Rosa, CA 95405 | 2013-02-15 |
| 1841549979 | Karie Louise Klim | Marriage & Family Therapist | 182 Farmers Ln Ste 204, Santa Rosa, CA 95405 | 2012-09-05 |
| 1427314400 | Rachel E. Page | Counselor | 2447 Summerfield Rd., Santa Rosa, CA 95405 | 2012-04-04 |
| 1689991572 | Center for Integral Healing Inc. | Community Health Worker | 182 Farmers Lane, #203, Santa Rosa, CA 95405 | 2010-04-30 |
| 1588997647 | Kai Morgan | Dentist | 1144 Suite 116 Soonoma Ave, Santa Rosa, CA 95405 | 2009-09-08 |
| Find all providers in zip 95405 | ||||
| Taxonomy Code | 207YX0905X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otolaryngology/Facial Plastic Surgery |
| An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316268386 | Charles Robert Pettit Md A Medical Corporation | Otolaryngology | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2010-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073159406 | Bh Ent Group Inc | Otolaryngology | 9033 Wilshire Blvd Ste 409, Beverly Hills, CA 90211-1847 | 2019-11-20 |
| 1942719570 | Beverly Hills Head and Neck Associates | Otolaryngology | 9401 Wilshire Blvd Ste 650, Beverly Hills, CA 90212-2913 | 2017-09-27 |
| 1083135065 | Jeffrey Jumaily Md Inc | Otolaryngology | 8816 Burton Way # 1, Beverly Hills, CA 90211-1715 | 2017-06-29 |
| 1558881771 | Bel Air Surgical Institute | Otolaryngology | 11847 Wilshire Blvd Ste 302, Los Angeles, CA 90025-6634 | 2017-06-20 |
| 1912371352 | Ent Surgical Specialists Inc. | Otolaryngology | 6424 W Olympic Blvd, Los Angeles, CA 90048-5347 | 2015-11-23 |
| 1437536216 | Kiersten L. Riedler | Otolaryngology | 5405 Oberlin Dr Fl 2, San Diego, CA 92121-1700 | 2015-04-30 |
| 1114344025 | Ryan M Casserly | Otolaryngology | 966 Cass St Ste 250, Monterey, CA 93940-4541 | 2014-03-28 |
| 1558798611 | Stephen Dow Proffitt | Otolaryngology | 172 Admiral Way, Costa Mesa, CA 92627-1397 | 2013-10-03 |
| 1447693973 | Jacob Lee Wester | Otolaryngology | 200 Medical Plaza Driveway Ste 550, Ucla Department of Head and Neck Surgery, Los Angeles, CA 90095-0001 | 2013-04-15 |
| 1396002606 | Michael Hall | Otolaryngology | 355 Lennon Ln Ste 235, Walnut Creek, CA 94598-2544 | 2012-04-12 |
| Find all providers with the same taxonomy | ||||
| City | SANTA ROSA |
| Zip Code | 95405 |
Please comment or provide details below to improve the information on ENTEGRATIVE OTOLARYNGOLOGY PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.