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General NPI Number Information
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NPI Number | 1235400318
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Entity Type | Organization
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Legal Business Name | SONOMA AMBULATORY ANESTHESIA GROUP, INC.
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 1210 SONOMA AVE STE. B
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City | SANTA ROSA
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State | CA
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Zip | 95405-6648
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Country | US
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Telephone | 707-571-2192
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Fax | 843-357-4940
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Provider Business Mailing Address
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Address Line | PO BOX 4860
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City | MURRELLS INLET
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State | SC
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Zip | 29576-2698
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Country | US
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Telephone | 843-651-2624
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Fax | 843-357-4940
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MICHAEL T. MITCHELL
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Credential |
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Telephone | 843-651-2624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | C3255198
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License Number State | CA
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