Provider Demographics
NPI:1366205460
Name:PNC MSK PC
Entity type:Organization
Organization Name:PNC MSK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:KOJI
Authorized Official - Last Name:FUJII
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-200-0087
Mailing Address - Street 1:3536 MENDOCINO AVE STE 300B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-237-3410
Mailing Address - Fax:833-615-2399
Practice Address - Street 1:3536 MENDOCINO AVE STE 300B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3634
Practice Address - Country:US
Practice Address - Phone:707-237-3410
Practice Address - Fax:833-615-2399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PNC MSK PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty