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Organization
SONOMA TRAIL MEDICAL SERVICES, A MED CORP
Active
Organization
SONOMA TRAIL MEDICAL SERVICES, A MED CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES T MITCHELL (OFFICER)
(469) 401-2386
Entity
Organization
Contact information
Practice address
555 S 7TH AVE, BARSTOW, CA 92311-3043
(469) 401-2386
Mailing address
PO BOX 98576, LAS VEGAS, NV 89193-8576
(469) 401-2386
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/12/2015
Last updated
10/12/2015
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