Basic Information
| Provider Information | |||||||||
| NPI: | 1649382342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SORBERA | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8715 CENTER PKWY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958237921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094643627 | ||||||||
| FaxNumber: | 2094643630 | ||||||||
| Practice Location | |||||||||
| Address1: | 1805 N CALIFORNIA ST | ||||||||
| Address2: | STE 303 | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952046033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094643627 | ||||||||
| FaxNumber: | 2094643630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | A74942 | CA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 340019374 | 01 | CA | RAILROAD MEDICARE | OTHER | A74942 | 01 | CA | LICENSE | OTHER | 040752 | 01 | CA | HILL PHYSICIANS | OTHER |