Provider Demographics
NPI:1912561580
Name:SORGMAN, CHRISTINE GALE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:GALE
Last Name:SORGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 OPPORTUNITY DR STE 6A
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3008
Mailing Address - Country:US
Mailing Address - Phone:916-899-5925
Mailing Address - Fax:916-899-5923
Practice Address - Street 1:2003 OPPORTUNITY DR STE 6A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3008
Practice Address - Country:US
Practice Address - Phone:916-899-5925
Practice Address - Fax:916-899-5923
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314700012253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA253Z00000XMedicaid