Provider Demographics
NPI:1275187338
Name:VANMALI, SONIA NATASHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:NATASHA
Last Name:VANMALI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20555 DEVONSHIRE ST # 432
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3208
Mailing Address - Country:US
Mailing Address - Phone:818-625-9342
Mailing Address - Fax:
Practice Address - Street 1:1919 STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-0406
Practice Address - Country:US
Practice Address - Phone:818-625-9342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-27
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist