Provider Demographics
NPI:1639230444
Name:SONIDO, MARIETTA V (MD)
Entity type:Individual
Prefix:
First Name:MARIETTA
Middle Name:V
Last Name:SONIDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIETTA
Other - Middle Name:G
Other - Last Name:SONIDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1635 CENTRAL AVENUE ROOM 213
Mailing Address - Street 2:SOUTHWEST CT MENTAL HEALTH SYSTEM ATTN SANDRA GRAZYNSKI
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610
Mailing Address - Country:US
Mailing Address - Phone:203-551-7660
Mailing Address - Fax:203-551-7481
Practice Address - Street 1:1635 CENTRAL AVENUE ROOM 213
Practice Address - Street 2:SOUTHWEST CT MENTAL HEALTH SYSTEM ATTN SANDRA GRAZYNSKI
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610
Practice Address - Country:US
Practice Address - Phone:203-551-7660
Practice Address - Fax:203-551-7481
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016402207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F21170Medicare UPIN