Healthcare Provider Details

I. General information

NPI: 1922187962
Provider Name (Legal Business Name): GEORGE M SONNEBORN AFE23957
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE M SONNERBORN M.D.

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 N FAIR OAKS AVE # 200
PASADENA CA
91103-1620
US

IV. Provider business mailing address

854 MURIETTA DR
ARCADIA CA
91007-6028
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-6300
  • Fax: 626-398-5840
Mailing address:
  • Phone: 626-398-6300
  • Fax: 626-398-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberAFE23957
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAFE23957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: