Provider Demographics
NPI:1932615507
Name:STREET, SONRISA ALISON
Entity Type:Individual
Prefix:MRS
First Name:SONRISA
Middle Name:ALISON
Last Name:STREET
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 1:7968 NE CAITLIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6862
Mailing Address - Country:US
Mailing Address - Phone:509-301-4410
Mailing Address - Fax:
Practice Address - Street 1:16315 SW BARROWS RD STE 203A
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9461
Practice Address - Country:US
Practice Address - Phone:503-746-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22981207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine