Healthcare Provider Details

I. General information

NPI: 1063882975
Provider Name (Legal Business Name): SONIA ELIZABETH BIBLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9045 BRUCEVILLE RD STE 100
ELK GROVE CA
95758-5950
US

IV. Provider business mailing address

9045 BRUCEVILLE RD STE 100
ELK GROVE CA
95758-5950
US

V. Phone/Fax

Practice location:
  • Phone: 916-479-9110
  • Fax: 916-226-2656
Mailing address:
  • Phone: 916-479-9110
  • Fax: 916-226-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109202
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9109202
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number52901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: