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General NPI Number Information
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NPI Number | 1811027907
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Entity Type | Organization
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Legal Business Name | NAPA VALLEY SPINE, INC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 1860 PENNSYLVANIA AVE SUITE 320
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City | FAIRFIELD
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State | CA
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Zip | 94533-3590
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Country | US
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Telephone | 707-422-1101
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Fax | 707-422-1205
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Provider Business Mailing Address
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Address Line | PO BOX 1214
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City | ALAMO
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State | CA
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Zip | 94507-7214
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Country | US
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Telephone | 707-422-1101
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Fax | 707-422-1205
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES MICHAEL SONU
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Credential | MD
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Telephone | 707-422-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | G69079
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License Number State | CA
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