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General NPI Number Information
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NPI Number | 1508973371
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Entity Type | Organization
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Legal Business Name | SONOMA PLAZA PEDIATRICS MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 181 ANDRIEUX STREET ST # 208
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City | SONOMA
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State | CA
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Zip | 95476-6920
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Country | US
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Telephone | 707-935-9000
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Fax | 707-935-8374
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Provider Business Mailing Address
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Address Line | 181 ANDRIEUX STREET ST. # 208
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City | SONOMA
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State | CA
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Zip | 95476-6920
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Country | US
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Telephone | 707-935-9000
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Fax | 707-935-8374
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Authorized Official
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Title or Position | M.D./CEO
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Name | MR. CHARLES FRANCIS DE TORRES
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Credential | M.D.
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Telephone | 707-935-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A62474
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License Number State | CA
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