MARK R HOMICZ (NPI# 1336198449) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336198449 |
| Entity Type | Individual |
| Full Name | MARK R HOMICZ |
| Credential | M.D. |
| Practice Address |
1701 4th St Ste 120 Santa Rosa CA 95404-3661 |
| Mailing Address |
3536 Mendocino Ave Ste 200 Santa Rosa CA 95403-3634 |
| Practice Telephone | 7075237025 |
| Practice Fax Number | 7075233024 |
| Mailing Telephone | 7075756049 |
| Mailing Fax Number | 7075233024 |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2012-02-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | A70413 | CA | Allopathic & Osteopathic Physicians |
| N | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
A70413 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE SHIELD OF CALIFORNIA | 00A704130 | 01 |
| CA | RAILROAD MEDICARE | P00933198 | 01 |
| Street Address |
1701 4TH ST STE 120 |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95404-3661 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063486546 | Kim Elaine Schmitt | Otolaryngology | 1701 4th St Ste 120, Santa Rosa, CA 95404 | 2006-02-14 |
| 1205213170 | Annick Aubin-pouliot | Otolaryngology | 1701 4th St Ste 120, Santa Rosa, CA 95404-3661 | 2015-04-30 |
| 1982947404 | Elizabeth Debra Cedars | Otolaryngology | 1701 4th St Ste 120, Santa Rosa, CA 95404 | 2013-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205442217 | David Lee Dutton | Counselor | 201 S. E Street, Santa Rosa, CA 95404 | 2020-09-16 |
| 1114492162 | Jesse Earl Rathbun Jr. | Ophthalmology | 1920 Grace Dr., Santa Rosa, CA 95404 | 2018-10-05 |
| 1568958437 | Bianca Avina | Marriage & Family Therapist | 95 Montgomery Dr. #112, Santa Rosa, CA 95404 | 2018-07-03 |
| 1366940504 | New Leaf Counseling and Psychotherapy | Marriage & Family Therapist | 1030 2n Street, Suite B, Santa Rosa, CA 95404 | 2018-01-23 |
| 1659884864 | Jessica Vargas Lopez | Counselor | 3333 Chanate Road, Santa Rosa, CA 95404 | 2017-11-09 |
| 1982135992 | Gaea Keridwyn Coon | Marriage & Family Therapist | 884 Third Street, Suite D, Santa Rosa, CA 95404 | 2017-03-22 |
| 1376084699 | Empire Traditional Chinese Medicine | Acupuncturist | 1030 Second St, Santa Rosa, CA 95404 | 2017-03-20 |
| 1356888705 | Webster Surgery Center, Lp | Clinic/Center | 730 Bennett Valley Road, Santa Rosa, CA 95404 | 2017-01-24 |
| 1205295979 | Sandra Lee Krikorian | Social Worker | 101 E Street, Suite 312, Santa Rosa, CA 95404 | 2016-02-23 |
| 1396134615 | The Center for Body Oriented Psychotherapy & Wellness | Psychologist | 1626 Fourth Street, Santa Rosa, CA 95404 | 2015-01-12 |
| Find all providers in zip 95404 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477528859 | Alexander J Lozano | Otolaryngology | 2025 Bent Tree Pl, Santa Rosa, CA 95404-1570 | 2006-02-21 |
| 1063486546 | Kim Elaine Schmitt | Otolaryngology | 1701 4th St Ste 120, Santa Rosa, CA 95404 | 2006-02-14 |
| 1205213170 | Annick Aubin-pouliot | Otolaryngology | 1701 4th St Ste 120, Santa Rosa, CA 95404-3661 | 2015-04-30 |
| 1982947404 | Elizabeth Debra Cedars | Otolaryngology | 1701 4th St Ste 120, Santa Rosa, CA 95404 | 2013-04-03 |
| 1760717441 | North Coast Faculty Medical Group Inc. | Otolaryngology | 1144 Sonoma Ave, 101, Santa Rosa, CA 95405-4812 | 2009-10-13 |
| 1023246089 | Anton Kushnaryov | Otolaryngology | 1701 4th St, Ste 120, Santa Rosa, CA 95404-3661 | 2009-06-30 |
| 1225203862 | Richard Turley | Otolaryngology | 401 Bicentennial Way, Santa Rosa, CA 95403-2149 | 2008-04-24 |
| 1699963231 | Stephanie Su Huang | Otolaryngology | 1701 4th St, Ste 120, Santa Rosa, CA 95404-3661 | 2007-10-09 |
| 1346315181 | Dr Jeff Broffman A Medical Corp | Otolaryngology | 1144 Sonoma Ave, #101, Santa Rosa, CA 95405 | 2006-11-21 |
| 1881773927 | Charles Daniel Sooy | Otolaryngology | 401 Bicentennial Way, Santa Rosa, CA 95403-2149 | 2006-11-02 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 95404 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.