Provider Demographics
NPI:1336830082
Name:LEDOUX-SONOMA, NATASHA T
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:T
Last Name:LEDOUX-SONOMA
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:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-0122
Mailing Address - Country:US
Mailing Address - Phone:808-425-6860
Mailing Address - Fax:
Practice Address - Street 1:122 PAGO PAGO ST.
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-0122
Practice Address - Country:US
Practice Address - Phone:808-425-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335G00000XSuppliersMedical Foods Supplier
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)