Healthcare Provider Details

I. General information

NPI: 1760461891
Provider Name (Legal Business Name): DONNA JANE SORENSEN PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

150 MUIR RD VA NCHCS
MARTINEZ CA
94553
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax: 925-372-2830
Mailing address:
  • Phone: 925-372-2000
  • Fax: 925-372-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY13878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: