1487785101 NPI number — DR. VALERIE SONDRA GARDEN M.D.

Table of content: DR. VALERIE SONDRA GARDEN M.D. (NPI 1487785101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487785101 NPI number — DR. VALERIE SONDRA GARDEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDEN
Provider First Name:
VALERIE
Provider Middle Name:
SONDRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARDEN
Provider Other First Name:
VALERIE
Provider Other Middle Name:
SONDRA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487785101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 SONOMA AVENUE
Provider Second Line Business Mailing Address:
BUILDING 2A
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95405-4817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-542-1225
Provider Business Mailing Address Fax Number:
707-542-6503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 SONOMA AVENUE
Provider Second Line Business Practice Location Address:
BUILDING 2A
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95405-4817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-542-1225
Provider Business Practice Location Address Fax Number:
707-542-6503
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  A52403 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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