Provider Demographics
NPI:1356568984
Name:BLEDSOE, SONIA (MD)
Entity type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:BLEDSOE
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 1:150 GOLDEN GATE AVE 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3810
Mailing Address - Country:US
Mailing Address - Phone:415-592-2711
Mailing Address - Fax:415-440-7776
Practice Address - Street 1:121 GOLDEN GATE AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3809
Practice Address - Country:US
Practice Address - Phone:415-241-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42140261QC1500X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine