Organization
SONOMA DIABETIC SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHEILA RAE FANUCCCHI RN (OWNER)
(707) 938-2667
Entity
Organization
Contact information
Practice address
246 PERKINS ST, SONOMA, CA 95476-6954
(707) 938-2667
(707) 938-5402
Mailing address
246 PERKINS ST, SONOMA, CA 95476-6954
(707) 938-2667
(707) 938-5402
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
PHA462690
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA462690
—
CA
Enumeration date
11/29/2006
Last updated
08/22/2020
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