Healthcare Provider Details

I. General information

NPI: 1144325838
Provider Name (Legal Business Name): SONORA SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MORNING STAR DR
SONORA CA
95370
US

IV. Provider business mailing address

905 MORNING STAR DR
SONORA CA
95370
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-1211
  • Fax: 209-536-0146
Mailing address:
  • Phone: 209-536-1211
  • Fax: 209-536-0146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. MICHELLE GEORGE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 209-536-1211