Provider Demographics
NPI:1720096795
Name:SONOMURA, SHERRIE (MPH RD CDCES)
Entity Type:Individual
Prefix:
First Name:SHERRIE
Middle Name:
Last Name:SONOMURA
Suffix:
Gender:F
Credentials:MPH RD CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 VICTORIA ST APT 703
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1450
Mailing Address - Country:US
Mailing Address - Phone:415-793-5679
Mailing Address - Fax:
Practice Address - Street 1:1221 VICTORIA ST APT 703
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1450
Practice Address - Country:US
Practice Address - Phone:415-793-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILD-188133V00000X
HI813064133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN