Organization
PETALUMA HEALTH CENTER INC
Active
Other names
Bolinas Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY JOUANEH (CFO)
(707) 559-7500
Entity
Organization
Contact information
Practice address
88 MESA RD, BOLINAS, CA 94924-9713
(415) 868-0124
(415) 868-2152
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
110000397
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC03885G
—
CA
Enumeration date
09/05/2006
Last updated
06/08/2021
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