Provider Demographics
NPI:1821674839
Name:MANN, SONJA ANGELIQUE
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:ANGELIQUE
Last Name:MANN
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 1:1535 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1513
Mailing Address - Country:US
Mailing Address - Phone:702-956-7903
Mailing Address - Fax:
Practice Address - Street 1:820 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-2729
Practice Address - Country:US
Practice Address - Phone:760-326-0222
Practice Address - Fax:760-326-0221
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95027708207Q00000X
NV832827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine