Healthcare Provider Details

I. General information

NPI: 1891732418
Provider Name (Legal Business Name): SONORA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MONO WAY
SONORA CA
95370-5229
US

IV. Provider business mailing address

1000 GREENLEY RD
SONORA CA
95370-5200
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-6940
  • Fax: 209-536-6952
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGORY MCCULLOCH
Title or Position: PRESIDENT
Credential:
Phone: 209-536-5019