Provider Demographics
NPI:1053608620
Name:WHITE, SONYA (LMT)
Entity type:Individual
Prefix:MS
First Name:SONYA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 BALBOA ST
Mailing Address - Street 2:STE. A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2731
Mailing Address - Country:US
Mailing Address - Phone:415-786-1596
Mailing Address - Fax:415-752-7233
Practice Address - Street 1:3223 BALBOA ST
Practice Address - Street 2:STE. A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2731
Practice Address - Country:US
Practice Address - Phone:415-786-1596
Practice Address - Fax:415-752-7233
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304 H71174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA304 H71OtherCITY & COUNTY OF SAN FRANCISCO MASSAGE LICENSE CERTIFICATE