Provider Demographics
NPI:1821233628
Name:SONNIER, BERNADINE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:BERNADINE
Middle Name:
Last Name:SONNIER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 STATE STREET
Mailing Address - Street 2:ENT CLINIC, CLINIC TOWER, ROOM A2E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:323-409-5070
Mailing Address - Fax:323-441-8128
Practice Address - Street 1:1100 STATE STREET
Practice Address - Street 2:ENT CLINIC, CLINIC TOWER, ROOM A2E
Practice Address - City:LOS ANGELE
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-409-5070
Practice Address - Fax:323-441-8128
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11976363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant