Healthcare Provider Details

I. General information

NPI: 1568461267
Provider Name (Legal Business Name): SONOMA COUNTY INDIAN HEALTH PROJECT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STONY POINT RD
SANTA ROSA CA
95401-4122
US

IV. Provider business mailing address

144 STONY POINT RD
SANTA ROSA CA
95401-4122
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-4585
  • Fax: 707-521-4599
Mailing address:
  • Phone: 707-521-4585
  • Fax: 707-521-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY45307
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BETTY ARTERBERRY
Title or Position: INTERIM CEO
Credential:
Phone: 707-521-4660