Healthcare Provider Details

I. General information

NPI: 1144632720
Provider Name (Legal Business Name): SONOMA SLEEP SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 HENNO RD
GLEN ELLEN CA
95442-8796
US

IV. Provider business mailing address

12150 HENNO RD
GLEN ELLEN CA
95442-8796
US

V. Phone/Fax

Practice location:
  • Phone: 510-501-0231
  • Fax:
Mailing address:
  • Phone: 510-501-0231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number00G213160
License Number StateCA

VIII. Authorized Official

Name: DR. JERROLD KRAM
Title or Position: PRESIDENT
Credential: MD
Phone: 510-501-0231