MEDICARE: SONDRA J ALTMAN MD INC A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	G44014	CA

General Provider Information

NPI Number	:	1720300197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONDRA J ALTMAN MD INC A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	120 LA CASA VIA
Second Line	:	SUITE 104
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3067
Country	:	US
Telephone Number	:	925-947-5945
Fax Number	:	925-947-5523

Provider Business Practice Location Address
First Line	:	120 LA CASA VIA
Second Line	:	SUITE 104
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3067
Country	:	US
Telephone Number	:	925-947-5945
Fax Number	:	925-947-5523

Authorized Official
Title or Position	:	CEO
Name	:	DR. SONDRA JOYCE ALTMAN
Credential	:	M.D.
Telephone Number	:	925-947-5945

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	06/16/2010

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