Provider Demographics
NPI:1053675488
Name:SONORA PRIMARY CARE
Entity Type:Organization
Organization Name:SONORA PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-532-3370
Mailing Address - Street 1:13951 MONO WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-2830
Mailing Address - Country:US
Mailing Address - Phone:209-532-3370
Mailing Address - Fax:209-532-3340
Practice Address - Street 1:13951 MONO WAY
Practice Address - Street 2:SUITE A
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-2830
Practice Address - Country:US
Practice Address - Phone:209-532-3370
Practice Address - Fax:209-532-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty