Provider Demographics
NPI:1699825067
Name:COUNTY OF SONOMA
Entity Type:Organization
Organization Name:COUNTY OF SONOMA
Other - Org Name:DEPARTMENT OF HEALTH - CENTER FOR HIV PREVENTION AND CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT III COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:STORNETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-565-4782
Mailing Address - Street 1:499 HUMBOLDT ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:499 HUMBOLDT ST STE 104
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4214
Practice Address - Country:US
Practice Address - Phone:707-565-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SONOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ0818ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ15736ZMedicare PIN