MEDICARE: PETALUMA CITY SCHOOLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1720598451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETALUMA CITY SCHOOLS

Provider Business Mailing Address
First Line	:	200 DOUGLAS ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2567
Country	:	US
Telephone Number	:	707-778-4614
Fax Number	:	707-778-5071

Provider Business Practice Location Address
First Line	:	200 DOUGLAS ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2567
Country	:	US
Telephone Number	:	707-778-4614
Fax Number	:	707-778-5071

Authorized Official
Title or Position	:	CBO
Name	:	MRS. CHRISTINE THOMAS
Credential	:
Telephone Number	:	707-778-4621

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	10/09/2017

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Directions to “PETALUMA CITY SCHOOLS ” Practice Location

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