Healthcare Provider Details

I. General information

NPI: 1336593755
Provider Name (Legal Business Name): GLENCY SUE MARIE SENIRES COROMINAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 STONY CIR STE 1600
SANTA ROSA CA
95401-9520
US

IV. Provider business mailing address

131 STONY CIR STE 1600
SANTA ROSA CA
95401-9520
US

V. Phone/Fax

Practice location:
  • Phone: 707-541-7700
  • Fax:
Mailing address:
  • Phone: 707-541-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA158545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: