OrganizationActive
4th Street Laser & Surgery Center Inc
NPI 1902964174 · Ambulatory Surgical Clinic/Center · Santa Rosa, CA
Provider details
- NPI number
- 1902964174
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Authorized official
- Elayne Clark, Administrator
- License
- 110000344 (CA)
Practice location
1720 4th St
Santa Rosa, CA 95404-3602
Phone: (707) 546-8100
Fax: (707) 544-6438
Mailing address
1720 4th St
Santa Rosa, CA 95404-3602
Registry dates
- Enumerated
- 2006-12-04
- Last updated
- 2013-01-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.