Provider Demographics
NPI:1720137649
Name:SONOMA SURGICAL A CORP
Entity type:Organization
Organization Name:SONOMA SURGICAL A CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-539-5151
Mailing Address - Street 1:4975 SONOMA HWY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4240
Mailing Address - Country:US
Mailing Address - Phone:707-539-5151
Mailing Address - Fax:707-539-7145
Practice Address - Street 1:4975 SONOMA HWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4240
Practice Address - Country:US
Practice Address - Phone:707-539-5151
Practice Address - Fax:707-539-7145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASRJH 27-070681332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0549580001Medicare NSC