Provider Demographics
NPI:1316392657
Name:LINDSTROM, SORREN
Entity Type:Individual
Prefix:
First Name:SORREN
Middle Name:
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 DREW AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7848
Mailing Address - Country:US
Mailing Address - Phone:530-285-3201
Mailing Address - Fax:530-758-2109
Practice Address - Street 1:500 B JEFFERSON BOULEVARD
Practice Address - Street 2:SUITES #180 & #195
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605
Practice Address - Country:US
Practice Address - Phone:916-403-2900
Practice Address - Fax:530-204-5248
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA163728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine