Provider Demographics
NPI:1033354089
Name:SWEET, LA SONYANETTE
Entity Type:Individual
Prefix:
First Name:LA
Middle Name:SONYANETTE
Last Name:SWEET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 TUNIS RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-1061
Mailing Address - Country:US
Mailing Address - Phone:510-909-7065
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE BLDG B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-553-8500
Practice Address - Fax:510-553-8550
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801983960OtherCHANGES ICM