Provider Demographics
NPI:1588199178
Name:SIGUENZA, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:SIGUENZA
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 1:11362 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3114
Mailing Address - Country:US
Mailing Address - Phone:310-874-9711
Mailing Address - Fax:
Practice Address - Street 1:11362 LOUISE AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3114
Practice Address - Country:US
Practice Address - Phone:310-874-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69520126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA69520Medicaid