Provider Demographics
NPI:1629385976
Name:WANEBO, SONJA MONIK (MD)
Entity Type:Individual
Prefix:DR
First Name:SONJA
Middle Name:MONIK
Last Name:WANEBO
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:PO BOX 1598
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-1598
Mailing Address - Country:US
Mailing Address - Phone:858-699-0572
Mailing Address - Fax:
Practice Address - Street 1:7301 E 2ND ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5600
Practice Address - Country:US
Practice Address - Phone:858-699-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42765207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery