| Petaluma Valley Internal Medicine Inc | |
|
1250 Broadway Sonoma CA 95476-7500 | |
| (707) 262-6267 | |
| (707) 734-7766 |
| Full Name | Petaluma Valley Internal Medicine Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1250 Broadway, Sonoma, California |
| Authorized Official Name and Position | David G Streeter (PRESIDENT) |
| Authorized Official Contact | 7077651070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Petaluma Valley Internal Medicine Inc 1310 Commerce St #b Petaluma CA 94954-1469 Ph: (707) 778-7862 | Petaluma Valley Internal Medicine Inc 1250 Broadway Sonoma CA 95476-7500 Ph: (707) 262-6267 |
| NPI Number | 1326089806 |
|---|---|
| Provider Enumeration Date | 06/08/2006 |
| Last Update Date | 12/12/2018 |
| Medicare PECOS PAC ID | 1355340225 |
|---|---|
| Medicare Enrollment ID | O20061204000633 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326089806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | G55098 (California) | Primary |
| Provider Name | David G Streeter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952342057 PECOS PAC ID: 2264490606 Enrollment ID: I20041230000651 |
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