Healthcare Provider Details

I. General information

NPI: 1952232043
Provider Name (Legal Business Name): SUGAFLO PHYSICIAN ASSISTANT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 VALLEY HOUSE DR STE 210
ROHNERT PARK CA
94928-4938
US

IV. Provider business mailing address

1500 VALLEY HOUSE DR STE 210
ROHNERT PARK CA
94928-4938
US

V. Phone/Fax

Practice location:
  • Phone: 707-477-6446
  • Fax:
Mailing address:
  • Phone: 707-477-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FELTON MARSHALL
Title or Position: PHYSICIAN ASSISTANT
Credential: PA
Phone: 707-477-6446