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Organization
PETALUMA EMERGENCY PHYSICIANS MEDICAL CORPORATION
Active
Organization
PETALUMA EMERGENCY PHYSICIANS MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY FONG (MEDICAL DIRECTOR)
(707) 778-1111
Entity
Organization
Contact information
Practice address
400 N MCDOWELL BLVD, PETALUMA, CA 94954-2339
(707) 778-1111
Mailing address
PO BOX 4419, WOODLAND HILLS, CA 91365-4419
(818) 340-9988
(818) 444-7214
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
282NC0060X
Critical Access Hospital
G69103
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0105410
—
CA
Enumeration date
07/06/2006
Last updated
03/28/2024
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