Healthcare Provider Details

I. General information

NPI: 1881029395
Provider Name (Legal Business Name): COLEMAN AND FALLON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 PETALUMA BLVD N
PETALUMA CA
94952-2847
US

IV. Provider business mailing address

696 PETALUMA BLVD N
PETALUMA CA
94952-2847
US

V. Phone/Fax

Practice location:
  • Phone: 707-763-3161
  • Fax: 707-763-9829
Mailing address:
  • Phone: 707-763-3161
  • Fax: 707-763-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number7468
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS MICHAEL TOBIN
Title or Position: OWNER/HEARING AID SPECIALIST
Credential:
Phone: 707-763-3161