Provider Demographics
NPI:1114549623
Name:RASCON, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:RASCON
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 1:3465 MCNUTT RD
Mailing Address - Street 2:
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-9056
Mailing Address - Country:US
Mailing Address - Phone:575-915-1338
Mailing Address - Fax:575-915-1819
Practice Address - Street 1:3465 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9056
Practice Address - Country:US
Practice Address - Phone:575-915-1338
Practice Address - Fax:575-915-1819
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker