Provider Demographics
NPI:1407330723
Name:RASCON, SONIA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:RASCON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27127
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-7127
Mailing Address - Country:US
Mailing Address - Phone:505-688-8053
Mailing Address - Fax:
Practice Address - Street 1:6855 4TH ST NW STE B-2
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6100
Practice Address - Country:US
Practice Address - Phone:505-508-2752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3863225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist