Provider Demographics
NPI:1437389509
Name:BLUE HORIZONS CLINIC
Entity Type:Organization
Organization Name:BLUE HORIZONS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNENTAG
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:928-782-3819
Mailing Address - Street 1:1150 W 24TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8368
Mailing Address - Country:US
Mailing Address - Phone:928-782-3819
Mailing Address - Fax:928-783-6623
Practice Address - Street 1:1150 W 24TH ST STE F
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8368
Practice Address - Country:US
Practice Address - Phone:928-782-3819
Practice Address - Fax:928-783-6623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty