Provider Demographics
NPI:1770832479
Name:ANGELONE, SONYA BOLCH (MS, RD, CLT)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:BOLCH
Last Name:ANGELONE
Suffix:
Gender:F
Credentials:MS, RD, CLT
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 861
Mailing Address - Street 2:
Mailing Address - City:ROSS
Mailing Address - State:CA
Mailing Address - Zip Code:94957-0861
Mailing Address - Country:US
Mailing Address - Phone:415-509-3192
Mailing Address - Fax:415-457-3819
Practice Address - Street 1:2154 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2684
Practice Address - Country:US
Practice Address - Phone:415-509-3192
Practice Address - Fax:415-457-3819
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA711871133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered