Provider Demographics
NPI:1235323890
Name:BALDERRAMA-OLIVA, SONNIA (DRPH, MBA, RN)
Entity Type:Individual
Prefix:DR
First Name:SONNIA
Middle Name:
Last Name:BALDERRAMA-OLIVA
Suffix:
Gender:F
Credentials:DRPH, MBA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-5120
Mailing Address - Country:US
Mailing Address - Phone:214-476-7399
Mailing Address - Fax:314-856-1554
Practice Address - Street 1:4049 EISENHOWER ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1100
Practice Address - Country:US
Practice Address - Phone:972-898-1217
Practice Address - Fax:314-856-1554
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX612630171M00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health