Basic Information
| Provider Information | |||||||||
| NPI: | 1891854568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SONTAG | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | JORDAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503069490 | ||||||||
| FaxNumber: | 6503060250 | ||||||||
| Practice Location | |||||||||
| Address1: | 363 MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503069490 | ||||||||
| FaxNumber: | 6503060250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 05/28/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | G052976 | CA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.