Healthcare Provider Details

I. General information

NPI: 1992759195
Provider Name (Legal Business Name): JOANETTE SORKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR. 60MDOS/SGOH
TRAVIS AFB CA
94535
US

IV. Provider business mailing address

101 BODIN CIR. 60MDOS/SGOH
TRAVIS AFB CA
94535
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3489
  • Fax: 707-423-5144
Mailing address:
  • Phone: 707-423-3489
  • Fax: 707-423-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4672
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: