Healthcare Provider Details

I. General information

NPI: 1427703693
Provider Name (Legal Business Name): SONSY BEHAVIORAL A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 GARFIELD ST STE 6
RIVERSIDE CA
92503-3922
US

IV. Provider business mailing address

8990 GARFIELD ST STE 6
RIVERSIDE CA
92503-3922
US

V. Phone/Fax

Practice location:
  • Phone: 951-907-0966
  • Fax:
Mailing address:
  • Phone: 951-907-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NGOZI ANYANACHO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 951-907-0966