Healthcare Provider Details

I. General information

NPI: 1891649661
Provider Name (Legal Business Name): SONJA BONNIE MACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ARNOLD DR
MARTINEZ CA
94553-6538
US

IV. Provider business mailing address

2701 WINDING LN
ANTIOCH CA
94531-7113
US

V. Phone/Fax

Practice location:
  • Phone: 925-655-2507
  • Fax:
Mailing address:
  • Phone:
  • 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: