Organization
PETALUMA SURGICENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD LAVIGNA DPM (OWNER)
(707) 763-9325
Entity
Organization
Contact information
Practice address
1400 PROFESSIONAL DR, SUITE 102, PETALUMA, CA 94954-5110
(707) 763-9325
(707) 769-0751
Mailing address
1400 PROFESSIONAL DR, SUITE 102, PETALUMA, CA 94954-5110
(707) 763-9325
(707) 769-0751
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
110000263
CA
Other
Enumeration date
05/24/2007
Last updated
01/10/2013
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