Organization
SONOMA AMBULATORY ANESTHESIA GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. MITCHELL (BUSINESS MANAGER)
(843) 651-2624
Entity
Organization
Contact information
Practice address
1210 SONOMA AVE, STE. B, SANTA ROSA, CA 95405-6648
(707) 571-2192
(843) 357-4940
Mailing address
PO BOX 4860, MURRELLS INLET, SC 29576-2698
(843) 651-2624
(843) 357-4940
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C3255198
CA
Other
Enumeration date
01/20/2012
Last updated
01/20/2012
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