| Sonoma Bodega | |
|
3480 Bodega Ave Petaluma CA 94952 | |
| (510) 654-4004 | |
| (510) 317-1426 |
| Full Name | Sonoma Bodega |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3480 Bodega Ave, Petaluma, California |
| Authorized Official Name and Position | Sandy Hobson (QUALITY ASSURANCE DIRECTOR) |
| Authorized Official Contact | 5107255727 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sonoma Bodega 2275 Arlington Dr San Leandro CA 94578-1132 Ph: (510) 654-4004 | Sonoma Bodega 3480 Bodega Ave Petaluma CA 94952 Ph: (510) 654-4004 |
| NPI Number | 1588012611 |
|---|---|
| Provider Enumeration Date | 05/31/2016 |
| Last Update Date | 06/29/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588012611 | NPI | - | NPPES |
| 0015 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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