Provider Demographics
NPI:1467475392
Name:JOHN MUIR PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:JOHN MUIR PHYSICIAN NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PRACTICE ADM
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-952-2888
Mailing Address - Street 1:PO BOX 9017
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-0917
Mailing Address - Country:US
Mailing Address - Phone:925-952-2888
Mailing Address - Fax:925-952-2845
Practice Address - Street 1:1455 MONTEGO
Practice Address - Street 2:#104
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2990
Practice Address - Country:US
Practice Address - Phone:925-952-2888
Practice Address - Fax:925-952-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR006875EMedicaid
CAZZZ24842ZMedicare ID - Type Unspecified