Provider Demographics
NPI:1346758059
Name:COLEMAN, SONIA
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:
Last Name:COLEMAN
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 1:100 S MARTIN LUTHER KING BLVD APT 89106
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4314
Mailing Address - Country:US
Mailing Address - Phone:310-415-2814
Mailing Address - Fax:702-293-3664
Practice Address - Street 1:100 S MARTIN LUTHER KING BLVD APT 89106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4314
Practice Address - Country:US
Practice Address - Phone:310-415-2814
Practice Address - Fax:702-293-3664
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV$$$$$$$$$Medicaid