Provider Demographics
NPI:1255062329
Name:DEATON, SONIA CAROLINA (PA)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:CAROLINA
Last Name:DEATON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:CAROLINA
Other - Last Name:QUINTANILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:561-570-5172
Mailing Address - Fax:786-472-5770
Practice Address - Street 1:917 S PORT AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2301
Practice Address - Country:US
Practice Address - Phone:361-887-0584
Practice Address - Fax:361-887-0586
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA16613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program