Sonya Cooper, L.M.T #5343
Individual provider Active NPI Specialist · Edgewood, NM
NPI 1043425911 · NPPES record last updated Jun 8, 2012
Key facts
- NPI
- 1043425911
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 5343 (NM)
- Practice address
- 45 Derek James Dr
Edgewood, NM 87015-9707 - Phone
- (505) 217-5168
- NPI assigned
- May 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5343 | NM | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 5343 | NM | Yes |
Addresses
Primary practice location
45 Derek James Dr
Edgewood, NM 87015-9707
Mailing address
10255 Jarash PL NE
Albuquerque, NM 87122-3317
Phone (505) 217-5168
Other providers in Edgewood, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.