Provider Demographics
NPI:1922187962
Name:SONNEBORN, GEORGE M (AFE23957)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:SONNEBORN
Suffix:
Gender:M
Credentials:AFE23957
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:M
Other - Last Name:SONNERBORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:854 MURIETTA DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6028
Mailing Address - Country:US
Mailing Address - Phone:626-398-6300
Mailing Address - Fax:626-398-5840
Practice Address - Street 1:1855 N FAIR OAKS AVE # 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1620
Practice Address - Country:US
Practice Address - Phone:626-398-6300
Practice Address - Fax:626-398-5840
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE23957146N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA187689315OtherCHAP NPI
CAFHC70768FMedicaid
CAHAP70768FMedicaid
CAEAP70768FMedicaid