Healthcare Provider Details

I. General information

NPI: 1134327083
Provider Name (Legal Business Name): SONORA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 GUZZI LN SUITE 106
SONORA CA
95370-5288
US

IV. Provider business mailing address

14542 LOLLY LN
SONORA CA
95370-9226
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-3750
  • Fax: 209-532-9811
Mailing address:
  • Phone: 209-536-3900
  • Fax: 209-536-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW D. JAHN
Title or Position: VICE PRESIDENT FOR FINANCE
Credential:
Phone: 209-536-5011