Provider Demographics
NPI:1043425911
Name:COOPER, SONYA (LMT #5343)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMT #5343
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10255 JARASH PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3317
Mailing Address - Country:US
Mailing Address - Phone:505-217-5168
Mailing Address - Fax:
Practice Address - Street 1:45 DEREK JAMES DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-9707
Practice Address - Country:US
Practice Address - Phone:505-217-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist