| Sonoma Kuck Lane | |
|
365 Kuck Ln Petaluma CA 94952 | |
| (510) 654-4004 | |
| Not Available |
| Full Name | Sonoma Kuck Lane |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 365 Kuck Ln, Petaluma, California |
| Authorized Official Name and Position | Scott Osborn (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 5105200943 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sonoma Kuck Lane 8945 Golf Links Rd Oakland CA 94605-4124 Ph: (510) 317-1444 | Sonoma Kuck Lane 365 Kuck Ln Petaluma CA 94952 Ph: (510) 654-4004 |
| NPI Number | 1326412099 |
|---|---|
| Provider Enumeration Date | 11/18/2015 |
| Last Update Date | 08/19/2024 |
| Certification Date | 08/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326412099 | NPI | - | NPPES |
| 0015 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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