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General NPI Number Information
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NPI Number | 1346480381
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Entity Type | Organization
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Legal Business Name | SONOMA PSYCHO-ONCOLOGY
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 1480 LINCOLN AVE STE 7
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2085
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Country | US
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Telephone | 707-888-7845
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Fax |
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Provider Business Mailing Address
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Address Line | 18370 CLAYTON AVE
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City | SONOMA
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State | CA
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Zip | 95476-4214
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Country | US
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Telephone | 707-888-7845
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Fax | 707-935-1629
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MICHAEL STAPLES
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Credential | MFT
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Telephone | 707-888-7845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC39498
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License Number State | CA
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