| Cmhc Cloverdale | |
|
5350 Old Redwood Hwy North, Suite 600 Petaluma CA 94954 | |
| (707) 894-4715 | |
| Not Available |
| Full Name | Cmhc Cloverdale |
|---|---|
| Speciality | Clinic/Center |
| Location | 5350 Old Redwood Hwy North, Suite 600, Petaluma, California |
| Authorized Official Name and Position | Ruby Zhang (DEPARTMENT ANALYST) |
| Authorized Official Contact | 7075657846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cmhc Cloverdale 1360 N Mcdowell Blvd Ste 1a Petaluma CA 94954-1177 Ph: (707) 894-4715 | Cmhc Cloverdale 5350 Old Redwood Hwy North, Suite 600 Petaluma CA 94954 Ph: (707) 894-4715 |
| NPI Number | 1952637027 |
|---|---|
| Provider Enumeration Date | 10/26/2009 |
| Last Update Date | 10/04/2024 |
| Medicare PECOS PAC ID | 4688658651 |
|---|---|
| Medicare Enrollment ID | O20040616001152 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952637027 | NPI | - | NPPES |
| 49FP | Other | CA | PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Jennifer P Beck |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669523387 PECOS PAC ID: 5597655647 Enrollment ID: I20040319001247 |
| Provider Name | Tess M Lusher |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548210099 PECOS PAC ID: 3072597087 Enrollment ID: I20040616001469 |
| Provider Name | Gary Bravo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669536009 PECOS PAC ID: 3678557592 Enrollment ID: I20040616001594 |
| Provider Name | Neil P Ehrlich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013078625 PECOS PAC ID: 2163401464 Enrollment ID: I20040719001651 |
| Provider Name | Lennart H Moller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336224237 PECOS PAC ID: 3072560358 Enrollment ID: I20050407001357 |
| Provider Name | Michael Kozart |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013060888 PECOS PAC ID: 1456392927 Enrollment ID: I20050513000814 |
| Provider Name | Danielle Marie Pyevich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689764029 PECOS PAC ID: 5092785964 Enrollment ID: I20060201000143 |
| Provider Name | Clare L Maxwell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548452519 PECOS PAC ID: 2961566682 Enrollment ID: I20090126000125 |
| Provider Name | Zoe Martinez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740319581 PECOS PAC ID: 9234280959 Enrollment ID: I20090619000189 |
| Provider Name | Diana L Verde |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235347576 PECOS PAC ID: 5395896278 Enrollment ID: I20090707000040 |
| Provider Name | Paul Mascovich |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1215921184 PECOS PAC ID: 5597775791 Enrollment ID: I20100504000194 |
| Provider Name | Mary Margaret Ewing |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073652004 PECOS PAC ID: 9739375346 Enrollment ID: I20101122000902 |
| Provider Name | Naomi Granvold |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356425326 PECOS PAC ID: 6608065578 Enrollment ID: I20110107000016 |
| Provider Name | Neal H Adams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659407823 PECOS PAC ID: 7911189824 Enrollment ID: I20110315000208 |
| Provider Name | Susan L Ahart |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407924475 PECOS PAC ID: 8921268285 Enrollment ID: I20120322000678 |
| Provider Name | Nakul Varshney |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942413463 PECOS PAC ID: 1052564895 Enrollment ID: I20130103000463 |
| Provider Name | Jill Rothberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811044407 PECOS PAC ID: 5496978512 Enrollment ID: I20140519000729 |
| Provider Name | Sophie Aneson-macleon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316007156 PECOS PAC ID: 0345463907 Enrollment ID: I20140529000453 |
| Provider Name | Lisa M Walker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154399723 PECOS PAC ID: 4082706890 Enrollment ID: I20161021001371 |
| Provider Name | Naga Kothapalli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619301579 PECOS PAC ID: 4284934761 Enrollment ID: I20170628002707 |
| Provider Name | Angela Burt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992890222 PECOS PAC ID: 2567428618 Enrollment ID: I20170707000410 |
| Provider Name | Benjamin Ross Goldstein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982915963 PECOS PAC ID: 2365660297 Enrollment ID: I20180207002747 |
| Provider Name | Katherine S Cole |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447469192 PECOS PAC ID: 1850487406 Enrollment ID: I20180208002959 |
| Provider Name | David Nichols |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588933592 PECOS PAC ID: 0648531095 Enrollment ID: I20180227000765 |
| Provider Name | Matthew J Gardiner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629084710 PECOS PAC ID: 9133148794 Enrollment ID: I20190220002910 |
| Provider Name | Larissa A Pendergraft |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932404902 PECOS PAC ID: 6608107115 Enrollment ID: I20191015001956 |
| Provider Name | Kevin S Zhang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225370885 PECOS PAC ID: 6103258751 Enrollment ID: I20191119003333 |
| Provider Name | Victoria I Ojiako |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508403551 PECOS PAC ID: 3971934910 Enrollment ID: I20200507002148 |
| Provider Name | Katie Blake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104375393 PECOS PAC ID: 9436562345 Enrollment ID: I20210114001698 |
| Provider Name | Oluseun Ofuje Ajayi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114389178 PECOS PAC ID: 5193011591 Enrollment ID: I20210917002848 |
Northern California Medical Assoc Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 104 Lynch Creek Way, Ste 10, Petaluma, CA 94954 Phone: 707-782-9123 Fax: 707-782-9622 | |
Petaluma Eye Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1225 N Mcdowell Blvd, Petaluma, CA 94954 Phone: 707-559-7500 | |
Ranadive Md Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 141 Lynch Creek Way Ste C, Petaluma, CA 94954 Phone: 707-763-0802 Fax: 707-763-0803 | |
Nikola Lozanov, M. D., Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 108 Lynch Creek Way, Suite #4, Petaluma, CA 94954 Phone: 707-782-1244 Fax: 707-782-1163 | |
Headwaters Medical Therapy Unit Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1355 Industrial Ave, Petaluma, CA 94952 Phone: 707-565-8188 Fax: 707-565-8190 | |
Vivacitas Medical Group Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1383 N Mcdowell Blvd Ste 110, Petaluma, CA 94954 Phone: 707-766-9852 | |
Casa Grande High School Health Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 Casa Grande Rd, Petaluma, CA 94954 Phone: 707-559-7500 |