Provider Demographics
NPI:1811027907
Name:NAPA VALLEY SPINE, INC
Entity Type:Organization
Organization Name:NAPA VALLEY SPINE, INC
Other - Org Name:NORTH BAY SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SONU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-422-1101
Mailing Address - Street 1:PO BOX 1214
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-7214
Mailing Address - Country:US
Mailing Address - Phone:707-422-1101
Mailing Address - Fax:707-422-1205
Practice Address - Street 1:1860 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3590
Practice Address - Country:US
Practice Address - Phone:707-422-1101
Practice Address - Fax:707-422-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69079207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF83357Medicare UPIN
CA00G690790Medicare ID - Type Unspecified