| Sonoma Pain Management, Inc | |
|
1456 Professional Dr Ste 402 Petaluma CA 94954-6639 | |
| (707) 938-7951 | |
| (707) 938-7260 |
| Full Name | Sonoma Pain Management, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1456 Professional Dr Ste 402, Petaluma, California |
| Authorized Official Name and Position | Aimee C Chagnon (PRESIDENT) |
| Authorized Official Contact | 7079387951 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sonoma Pain Management, Inc 1456 Professional Dr Ste 402 Petaluma CA 94954-6639 Ph: (707) 938-7951 | Sonoma Pain Management, Inc 1456 Professional Dr Ste 402 Petaluma CA 94954-6639 Ph: (707) 938-7951 |
| NPI Number | 1386935039 |
|---|---|
| Provider Enumeration Date | 04/28/2011 |
| Last Update Date | 01/18/2023 |
| Certification Date | 01/18/2023 |
| Medicare PECOS PAC ID | 9234309683 |
|---|---|
| Medicare Enrollment ID | O20110823000494 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386935039 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | A778242 (California) | Primary |
| Provider Name | Aimee C Chagnon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548450448 PECOS PAC ID: 1153348016 Enrollment ID: I20051029000328 |
| Provider Name | Jeremy L Goodwin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1366547614 PECOS PAC ID: 4880662691 Enrollment ID: I20090928000295 |
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