Healthcare Provider Details

I. General information

NPI: 1659944247
Provider Name (Legal Business Name): SONOMA EMERGENCY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 ANDRIEUX ST
SONOMA CA
95476-6811
US

IV. Provider business mailing address

PO BOX 4419
WOODLAND HILLS CA
91365-4419
US

V. Phone/Fax

Practice location:
  • Phone: 707-935-5000
  • Fax: 818-587-2493
Mailing address:
  • Phone: 818-340-9988
  • Fax: 818-587-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FARAMARZ MOTTALEI
Title or Position: TREASURER
Credential: MD
Phone: 707-815-6146