Provider Demographics
NPI:1932306008
Name:SONORAN HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:SONORAN HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER SHC PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-326-2100
Mailing Address - Street 1:4580 E GRANT RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2648
Mailing Address - Country:US
Mailing Address - Phone:520-326-2100
Mailing Address - Fax:520-326-2110
Practice Address - Street 1:4580 E GRANT RD
Practice Address - Street 2:SUITE 160
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2648
Practice Address - Country:US
Practice Address - Phone:520-326-2100
Practice Address - Fax:520-326-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7265111N00000X
AZ6177225100000X
AZ5981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID NUMBER