Ellen Betty Kruusmagi
Family Doctor
144 Stony Point Rd
Santa Rosa
, California 95401
Ellen Betty Kruusmagi
Family Doctor
144 Stony Point Rd
Santa Rosa
, California 95401
(707) 544-4626
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About
Features
Specialties
- Family Doctor
Languages spoken
- English
Location
First Address
- Ellen Betty Kruusmagi
- 144 Stony Point Rd
- Santa Rosa, CA
- Zip : 95401
- Fax : (707) 544-4626
- Phone : (707) 521-4500
Second Address
- Ellen Betty Kruusmagi
- 144 Stony Point Rd
- Santa Rosa, CA
- Zip : 95401
- Fax : (707) 544-4626
- Phone : (707) 521-4500
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207Q00000X | Family Doctor | G61813 | CA |
National Provider Identifier
| NPI | 1003831793 |
|---|---|
| Provider Name | Ellen Betty Kruusmagi |
| First Address | Santa Rosa, CA 95401 |
| Second Address | Santa Rosa, CA 95401 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 13/07/2006 |
| Last Update Date | 18/04/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00G618130 | (05) | CA |
| E24990 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.