Provider Demographics
NPI:1508973371
Name:SONOMA PLAZA PEDIATRICS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SONOMA PLAZA PEDIATRICS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DE TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-935-9000
Mailing Address - Street 1:181 ANDRIEUX STREET ST. # 208
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6920
Mailing Address - Country:US
Mailing Address - Phone:707-935-9000
Mailing Address - Fax:707-935-8374
Practice Address - Street 1:181 ANDRIEUX STREET ST # 208
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6920
Practice Address - Country:US
Practice Address - Phone:707-935-9000
Practice Address - Fax:707-935-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770510521OtherNPI
CA1407884919OtherNPI
CA1629013339OtherNPI