Basic Information
| Provider Information | |||||||||
| NPI: | 1265455448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCAULIFFE | ||||||||
| FirstName: | NAOMI | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 DOYLE PARK DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954054570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075261800 | ||||||||
| FaxNumber: | 7075269352 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 DOYLE PARK DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954054570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075261800 | ||||||||
| FaxNumber: | 7075269352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A129605 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20A8315 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 81459076 | 05 | NM | MEDICAID |