Provider Demographics
NPI:1487785101
Name:GARDEN, VALERIE SONDRA (MD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:SONDRA
Last Name:GARDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:SONDRA
Other - Last Name:GARDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1140 SONOMA AVENUE
Mailing Address - Street 2:BUILDING 2A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4817
Mailing Address - Country:US
Mailing Address - Phone:707-542-1225
Mailing Address - Fax:707-542-6503
Practice Address - Street 1:1140 SONOMA AVENUE
Practice Address - Street 2:BUILDING 2A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4817
Practice Address - Country:US
Practice Address - Phone:707-542-1225
Practice Address - Fax:707-542-6503
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52403207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F69108Medicare UPIN
F691089Medicare UPIN
00A524030Medicare ID - Type Unspecified