Healthcare Provider Details

I. General information

NPI: 1669696506
Provider Name (Legal Business Name): MISS SONIA SERVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14277 ROAD 28
MADERA CA
93638-5715
US

IV. Provider business mailing address

4779 N CEDAR AVE APT 102
FRESNO CA
93726-1020
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-3508
  • Fax: 559-661-2818
Mailing address:
  • Phone: 559-243-9815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: