Healthcare Provider Details

I. General information

NPI: 1508973371
Provider Name (Legal Business Name): SONOMA PLAZA PEDIATRICS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 ANDRIEUX STREET ST # 208
SONOMA CA
95476-6920
US

IV. Provider business mailing address

181 ANDRIEUX STREET ST. # 208
SONOMA CA
95476-6920
US

V. Phone/Fax

Practice location:
  • Phone: 707-935-9000
  • Fax: 707-935-8374
Mailing address:
  • Phone: 707-935-9000
  • Fax: 707-935-8374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA62474
License Number StateCA

VIII. Authorized Official

Name: MR. CHARLES FRANCIS DE TORRES
Title or Position: M.D./CEO
Credential: M.D.
Phone: 707-935-9000