Healthcare Provider Details

I. General information

NPI: 1154656486
Provider Name (Legal Business Name): SONORA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12811 COVEY CIR
SONORA CA
95370-5935
US

IV. Provider business mailing address

14542 LOLLY LN
SONORA CA
95370-9226
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-5180
  • Fax: 209-536-3509
Mailing address:
  • Phone: 209-536-3900
  • Fax: 209-533-7696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW D. JAHN
Title or Position: CEO
Credential:
Phone: 209-536-5011