Healthcare Provider Details

I. General information

NPI: 1841126695
Provider Name (Legal Business Name): SONOME DIAGNOSTIC MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W ROUTE 66 STE 107
GLENDORA CA
91740-4166
US

IV. Provider business mailing address

620 W ROUTE 66 STE 107
GLENDORA CA
91740-4166
US

V. Phone/Fax

Practice location:
  • Phone: 951-289-7102
  • Fax:
Mailing address:
  • Phone: 951-289-7102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN NICOLE CACERES
Title or Position: CEO
Credential: RDMS
Phone: 951-289-7102