Organization
PETALUMA HEALTH CENTER INC
Active
Other names
Point Reyes Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY JOUANEH (CFO)
(707) 559-7500
Entity
Organization
Contact information
Practice address
3 SIXTH STREET, POINT REYES STATION, CA 94956-0910
(415) 663-8666
(415) 663-9532
Mailing address
1455 N MCDOWELL BLVD STE D, PETALUMA, CA 94954-6503
(707) 559-7500
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
110000399
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BCP70434F
—
CA
05
—
EAP70434F
—
CA
05
—
FHC70434F
—
CA
05
—
HAP70434F
—
CA
Enumeration date
08/29/2006
Last updated
06/08/2021
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