Provider Demographics
NPI:1790774446
Name:HINTZ, SONYA (MD)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:HINTZ
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 1:3252 HOLIDAY CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0027
Mailing Address - Country:US
Mailing Address - Phone:858-455-6511
Mailing Address - Fax:858-455-5747
Practice Address - Street 1:3252 HOLIDAY CT
Practice Address - Street 2:SUITE 100
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0027
Practice Address - Country:US
Practice Address - Phone:858-455-6511
Practice Address - Fax:858-455-5747
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-16
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG585612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG58561Medicaid
CAG58561Medicaid
G58561Medicare ID - Type Unspecified