Provider Demographics
NPI:1265527212
Name:SONORA PULMONARY AND CRITICAL CARE MEDICINE
Entity type:Organization
Organization Name:SONORA PULMONARY AND CRITICAL CARE MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LONG
Authorized Official - Middle Name:XUAN NGUYEN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-694-8390
Mailing Address - Street 1:900 GREENLEY RD STE 923
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5287
Mailing Address - Country:US
Mailing Address - Phone:209-694-8390
Mailing Address - Fax:209-694-8789
Practice Address - Street 1:900 GREENLEY RD STE 923
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5287
Practice Address - Country:US
Practice Address - Phone:209-694-8390
Practice Address - Fax:209-694-8789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79487207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty