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General NPI Number Information
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NPI Number | 1720480312
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Entity Type | Organization
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Legal Business Name | SONOITA SAGE CLINIC, PLLC
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 10/06/2014
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Provider Practice Location Address
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Address Line | 3123 ARIZONA HWY 83 B
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City | SONOITA
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State | AZ
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Zip | 85637
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Country | US
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Telephone | 520-415-0330
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 843
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City | SONOITA
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State | AZ
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Zip | 85637-0843
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Country | US
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Telephone | 520-415-0330
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MRS. ELAINE MARIAN HOOPER
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Credential | ANP/GNP, BC
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Telephone | 520-415-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AP6266
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License Number State | AZ
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