Provider Demographics
NPI:1013131481
Name:SONORA MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SONORA MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-297-3413
Mailing Address - Street 1:10808 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 160-439
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3889
Mailing Address - Country:US
Mailing Address - Phone:909-297-3413
Mailing Address - Fax:
Practice Address - Street 1:10808 FOOTHILL BLVD
Practice Address - Street 2:SUITE 160-439
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-297-3413
Practice Address - Fax:909-297-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital