Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 88 Mesa Rd, Bolinas, California |
Authorized Official Name and Position | Molly Jouaneh (CFO) |
Authorized Official Contact | 7075597500 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1455 N Mcdowell Blvd Ste D Petaluma CA 94954-6503 Ph: (707) 559-7500 | 88 Mesa Rd Bolinas CA 94924-9713 Ph: (415) 868-0124 |
NPI Number | 1760584049 |
---|---|
Provider Enumeration Date | 09/05/2006 |
Last Update Date | 06/08/2021 |
Medicare PECOS PAC ID | 9133180375 |
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Medicare Enrollment ID | O20200921001805 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760584049 | NPI | - | NPPES |
FHC03885G | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 110000397 (California) | Primary |