Provider Demographics
NPI:1780659953
Name:RICHARDS, SONIA B (MD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:B
Last Name:RICHARDS
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 1:6038 TAMPA AVE # 315
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1135
Mailing Address - Country:US
Mailing Address - Phone:818-633-4133
Mailing Address - Fax:
Practice Address - Street 1:16542 VENTURA BLVD STE 122
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-5034
Practice Address - Country:US
Practice Address - Phone:818-701-9211
Practice Address - Fax:818-701-6327
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46432174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G464321Medicaid
CAA50386Medicare UPIN