Provider Demographics
NPI:1386350072
Name:MARK V SOFONIO MD INC
Entity type:Organization
Organization Name:MARK V SOFONIO MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:SOFONIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-341-5555
Mailing Address - Street 1:71885 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4446
Mailing Address - Country:US
Mailing Address - Phone:760-341-5555
Mailing Address - Fax:
Practice Address - Street 1:71885 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4446
Practice Address - Country:US
Practice Address - Phone:760-341-5555
Practice Address - Fax:760-341-8054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty