PETALUMA HEALTH CENTER INC (NPI# 1588656268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588656268 |
| Entity Type | Organization |
| Organization Name | PETALUMA HEALTH CENTER INC |
| Other Organization Name | PETALUMA HEALTH CENTER |
| Practice Address |
1179 N Mcdowell Blvd Petaluma CA 94954-6559 |
| Practice Telephone | 7075597500 |
| Practice Fax Number | 7075597620 |
| Mailing Telephone | 7075597597 |
| Mailing Fax Number | 7076581319 |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2019-07-11 |
| Authorized Official Name | KATHRYN POWELL (CEO) |
| Authorized Official Telephone | 7075597500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BCP70696F | 05 | |
| CA | HAP70696F | 05 | |
| CA | FHC70696F | 05 | |
| CA | EAP70696F | 05 | |
| CA | MEDICARE NGS | 551879 | 01 |
| Other Name | Type Code |
|---|---|
| Petaluma Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295370195 | Petaluma Health Center Inc | Pharmacy | 5900 State Farm Dr Ste 200a, Rohnert Park, CA 94928-2149 | 2019-11-14 |
| 1669870739 | Petaluma Health Center Inc | Clinic/Center | 5900 State Farm Dr, Rohnert Park, CA 94928-2149 | 2014-12-05 |
| Street Address |
1179 N MCDOWELL BLVD |
| City | PETALUMA |
| State | CA |
| Zip Code | 94954-6559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366445785 | Michelle Davey | Family Medicine | 1179 N Mcdowell Blvd, Petaluma, CA 94954 | 2005-05-31 |
| 1942809256 | Rachel Pradarelli | Nurse Practitioner | 1179 N Mcdowell Blvd, Petaluma, CA 94954-6559 | 2020-10-19 |
| 1518573161 | Cicily Raye Cooper | Nurse Practitioner | 1179 N Mcdowell Blvd, Petaluma, CA 94954-6559 | 2020-09-18 |
| 1912512492 | Andrea Akabike | Dentist | 1179 N Mcdowell Blvd, Petaluma, CA 94954-6559 | 2020-09-11 |
| 1306479381 | Leslie Ann Burger | Nurse Practitioner | 1179 N Mcdowell Blvd, Petaluma, CA 94954-6559 | 2020-02-18 |
| 1932759461 | Joanna Tripet-diel | Nurse Practitioner | 1179 N Mcdowell Blvd, Petaluma, CA 94954-6559 | 2019-09-17 |
| 1588214019 | Colette Long | Registered Nurse | 1179 N Mcdowell Blvd, Petaluma, CA 94954-6559 | 2019-09-17 |
| 1184274615 | Mario Marin Garcia | Physician Assistant | 1179 N Mcdowell Blvd, Petaluma, CA 94954-6559 | 2019-09-17 |
| 1073162541 | Luisa Rendon Ward | Social Worker | 1179 N Mcdowell Blvd, Petaluma, CA 94954-6559 | 2019-09-08 |
| 1801356605 | Kelly Marie Ware | Nurse Practitioner | 1179 N Mcdowell Blvd, Petaluma, CA 94954-6559 | 2019-03-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346883840 | Miguel Ibarra | Counselor | 5350 Old Redwood Highway, Petaluma, CA 94954 | 2019-10-28 |
| 1073169223 | Monica Renee Najera | Behavior Technician | 1670 Corporate Circle, Ste. 100, Petaluma, CA 94954 | 2019-08-14 |
| 1326607201 | Making Magic Happen - People Helping People, Inc. | Marriage & Family Therapist | 1318 Redwood Way, Suite 260, Petaluma, CA 94954 | 2019-06-13 |
| 1477019917 | Rubi Isela Cruz Mendoza I | Behavioral Analyst | 8 Round Walk Circle, Petaluma, CA 94954 | 2019-02-20 |
| 1932679511 | Karen Christianson | Behavior Technician | 1670 Corporate Circle Suite 100, Petaluma, CA 94954 | 2018-11-27 |
| 1669956967 | Alyssa Messer | Assistant Behavior Analyst | 1670 Corporate Cir, Petaluma, CA 94954 | 2018-09-21 |
| 1235620592 | Mallory Paige Mullikin | Nurse Practitioner | 141 Lynch Creek Trail, Ste C, Petaluma, CA 94954 | 2018-05-22 |
| 1457723710 | Lisabel Dolne | Counselor | 1360 N. Mcdowell Blvd.1a, Petaluma, CA 94954 | 2015-10-27 |
| 1083080717 | Pacific Restorative Center | Clinic/Center | 1456 Professional Drive, Suite 404, Petaluma, CA 94954 | 2015-08-17 |
| 1619354198 | Accu Quest Hearing Centers | Clinic/Center | 1456 Professional Dr., Suite 404, Petaluma, CA 94954 | 2015-05-04 |
| Find all providers in zip 94954 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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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.