Provider Demographics
NPI:1265841563
Name:SONOITA SAGE CLINIC
Entity Type:Organization
Organization Name:SONOITA SAGE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:MARIAN
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP/GNP
Authorized Official - Phone:520-603-5151
Mailing Address - Street 1:PO BOX 843 SUITE B
Mailing Address - Street 2:AZ HWY 83
Mailing Address - City:SONOITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85637-0843
Mailing Address - Country:US
Mailing Address - Phone:520-415-0330
Mailing Address - Fax:760-705-8888
Practice Address - Street 1:3123 HWY 83
Practice Address - Street 2:SUITE B
Practice Address - City:SONOITA
Practice Address - State:AZ
Practice Address - Zip Code:85637-0843
Practice Address - Country:US
Practice Address - Phone:520-415-0330
Practice Address - Fax:760-705-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZANP0071261QH0100X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care