NPIMap

Organization Active NPI

Petaluma Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Petaluma, CA
National Provider Identifier
1972362952
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PETALUMA HEALTH CENTER, INC
Practice address
680 Sonoma Mountain Pkwy
Petaluma, CA 94954-8553
Phone
(707) 559-7500
NPI assigned
Mar 13, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Authorized official

Name
Molly Jouaneh
Title
Cfo
Phone
(707) 559-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

680 Sonoma Mountain Pkwy
Petaluma, CA 94954-8553

Mailing address

1455 N McDowell Blvd Ste D
Petaluma, CA 94954-6503
Phone (707) 559-7500

Other names 2

  • SRJC Petaluma Campus Student Health Services Clinic Doing business as
  • Santa Rosa Junior College - Petaluma Campus - Student Health Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Petaluma Health Center Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

680 Sonoma Mountain Pkwy
Petaluma, CA 94954

NPI Registry JSON

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

{
    "created_epoch": "1710288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1972362952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 N MCDOWELL BLVD STE D",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546503",
            "telephone_number": "707-559-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 SONOMA MOUNTAIN PKWY",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949548553",
            "telephone_number": "707-559-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETALUMA HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-13",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "JOUANEH",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "707-559-7500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SRJC Petaluma Campus Student Health Services Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Santa Rosa Junior College - Petaluma Campus - Student Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; 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.