Provider Demographics
NPI:1063502821
Name:SONOMA FAMILY PRACTICE MEDICAL ASSOCIATES P C
Entity Type:Organization
Organization Name:SONOMA FAMILY PRACTICE MEDICAL ASSOCIATES P C
Other - Org Name:JOHN R SCHAFER & CLAYTON F DRAKE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-938-3131
Mailing Address - Street 1:270 PERKINS STREET
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6955
Mailing Address - Country:US
Mailing Address - Phone:707-938-3131
Mailing Address - Fax:707-938-3678
Practice Address - Street 1:270 PERKINS STREET
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6955
Practice Address - Country:US
Practice Address - Phone:707-938-3131
Practice Address - Fax:707-938-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48627YOtherMEDICAL
CAYYY48627YOtherMEDICAL