MEDICARE: PETALUMA TAXI SERVICES LLC

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	344600000X	Taxi

General Provider Information

NPI Number	:	1760114078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETALUMA TAXI SERVICES LLC

Provider Business Mailing Address
First Line	:	409 JEFFERSON ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-3105
Country	:	US
Telephone Number	:	707-753-1186
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 JEFFERSON ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-3105
Country	:	US
Telephone Number	:	707-753-1186
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL WATKINS
Credential	:
Telephone Number	:	707-753-1186

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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Directions to “PETALUMA TAXI SERVICES LLC ” Practice Location

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