Provider Demographics
NPI:1336467679
Name:SONOMA HEALTH INSTITUTE PC
Entity Type:Organization
Organization Name:SONOMA HEALTH INSTITUTE PC
Other - Org Name:SALUS AT MAYACAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-569-2976
Mailing Address - Street 1:1240 MAYACAMA CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8251
Mailing Address - Country:US
Mailing Address - Phone:707-569-2972
Mailing Address - Fax:707-528-6725
Practice Address - Street 1:1240 MAYACAMA CLUB DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8251
Practice Address - Country:US
Practice Address - Phone:707-569-2972
Practice Address - Fax:707-528-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service