Healthcare Provider Details

I. General information

NPI: 1538206446
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CHANATE RD #49269R
SANTA ROSA CA
95404-1707
US

IV. Provider business mailing address

3333 CHANATE RD #49269R
SANTA ROSA CA
95404-1707
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4810
  • Fax:
Mailing address:
  • Phone: 707-565-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANA STORNETTA
Title or Position: ACCOUNTANT III COMPLIANCE
Credential:
Phone: 707-565-4782