Healthcare Provider Details

I. General information

NPI: 1700103827
Provider Name (Legal Business Name): PETALUMA VALLEY HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LYNCH CREEK WAY SUITE 9A
PETALUMA CA
94954-2356
US

IV. Provider business mailing address

106 LYNCH CREEK WAY SUITE 9A
PETALUMA CA
94954-2356
US

V. Phone/Fax

Practice location:
  • Phone: 866-853-3499
  • Fax:
Mailing address:
  • Phone: 866-853-3499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE A PILTCH
Title or Position: PRESIDENT
Credential:
Phone: 707-762-0103