Provider Demographics
NPI:1558397141
Name:JOHN MUIR PERINATAL MEDICAL GROUP
Entity Type:Organization
Organization Name:JOHN MUIR PERINATAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
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:925-941-7985
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:1656 N. CALFIORNIA BLVD.
Practice Address - Street 2:SUITE 300
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-941-7955
Practice Address - Fax:925-941-7986
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN MUIR PHYSICIAN NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-24
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR006875KMedicaid
CAGR006875KMedicaid