Provider Demographics
NPI:1790583714
Name:VICARIO, SONIA MARIE
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:MARIE
Last Name:VICARIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-3815
Mailing Address - Country:US
Mailing Address - Phone:760-623-0855
Mailing Address - Fax:
Practice Address - Street 1:1060 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-3815
Practice Address - Country:US
Practice Address - Phone:760-623-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist