Provider Demographics
NPI:1659914455
Name:ROSS, SONJA M
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:M
Last Name:ROSS
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 1:3223 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2007
Mailing Address - Country:US
Mailing Address - Phone:832-423-9956
Mailing Address - Fax:281-969-5308
Practice Address - Street 1:3223 N PARK DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2007
Practice Address - Country:US
Practice Address - Phone:832-423-9956
Practice Address - Fax:282-969-5308
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246YR1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246YR1600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationRegistered Record AdministratorGroup - Multi-Specialty