Coast Guard Training Center Petaluma

Primary specialty

Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X

Legal business name

COAST GUARD TRAINING CENTER PETALUMA

Practice address

599 Tomales Rd
Health Services Division
Petaluma, CA 94952-5002

Phone

(707) 765-7200

Fax

(707) 765-7521

NPI assigned

Dec 21, 2006

Last updated

May 7, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gerry Rodriguez

Title

Clinic Administrator

Phone

(707) 765-7200

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241654400000",
    "number": "1710041058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "599 TOMALES RD",
            "address_2": "HEALTH SERVICES DIVISION",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949525002",
            "telephone_number": "707-765-7200",
            "fax_number": "707-765-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "599 TOMALES RD",
            "address_2": "HEALTH SERVICES DIVISION",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949525002",
            "telephone_number": "707-765-7200",
            "fax_number": "707-765-7521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST GUARD TRAINING CENTER PETALUMA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2009-05-07",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "GERRY",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "707-765-7200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Military/U.S. Coast Guard Outpatient Clinic/Center in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Military/U.S. Coast Guard Outpatient Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.