NPIMap

Organization Active NPI

DRS. Ackley, Davis, Brewer, Miraglia, Anaka, Et Al.

  • Pediatrics Physician
  • Santa Rosa, CA
National Provider Identifier
1124066808
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
DRS. ACKLEY, DAVIS, BREWER, MIRAGLIA, ANAKA, ET AL.
Practice address
1200 Sonoma Ave Ste 6
Santa Rosa, CA 95405-6664
Phone
(707) 545-2545
Fax
(707) 545-1829
NPI assigned
Jun 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Edna Staples
Title
Office Manager
Phone
(707) 545-2545

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1200 Sonoma Ave Ste 6
Santa Rosa, CA 95405-6664

Mailing address

1200 Sonoma Ave Ste 6
Santa Rosa, CA 95405-6664
Phone (707) 545-2545

Other names 1

  • Pediatric Associates Sutter Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sutter Medical Group of the Redwoods5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124066808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SONOMA AVE STE 6",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954056664",
            "telephone_number": "707-545-2545",
            "fax_number": "707-545-1829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SONOMA AVE STE 6",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954056664",
            "telephone_number": "707-545-2545",
            "fax_number": "707-545-1829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS. ACKLEY, DAVIS, BREWER, MIRAGLIA, ANAKA, ET AL.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STAPLES",
        "authorized_official_first_name": "EDNA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "707-545-2545"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Associates Sutter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.