Provider Demographics
NPI:1346564101
Name:SONI, SOPHIA MONICA (MD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MONICA
Last Name:SONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 E 120TH ST
Mailing Address - Street 2:MEDICAL ADMINISTRATION, NSB
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3026
Mailing Address - Country:US
Mailing Address - Phone:424-338-1501
Mailing Address - Fax:310-632-3748
Practice Address - Street 1:1670 E 120TH ST
Practice Address - Street 2:MEDICAL ADMINISTRATION, NSB
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3026
Practice Address - Country:US
Practice Address - Phone:424-338-1501
Practice Address - Fax:310-632-3748
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100430OtherGROUP MEDI-CAL
CAW18762OtherGROUP MEDICARE
CAGR0100430OtherGROUP MEDI-CAL