Basic Information
| Provider Information | |||||||||
| NPI: | 1316392657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINDSTROM | ||||||||
| FirstName: | SORREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1590 DREW AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956187848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302853201 | ||||||||
| FaxNumber: | 5307582109 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 B JEFFERSON BOULEVARD | ||||||||
| Address2: | SUITES #180 & #195 | ||||||||
| City: | WEST SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164032900 | ||||||||
| FaxNumber: | 5302045248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2016 | ||||||||
| LastUpdateDate: | 06/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A163728 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.