Basic Information
| Provider Information | |||||||||
| NPI: | 1184624637 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEBASTIAN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 651 1ST ST W | ||||||||
| Address2: | SUITE H | ||||||||
| City: | SONOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954767045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079383870 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 651 1ST ST W | ||||||||
| Address2: | SUITE H | ||||||||
| City: | SONOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954767045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079383870 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2005 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A92199 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.