Healthcare Provider Details

I. General information

NPI: 1194379727
Provider Name (Legal Business Name): SONNY CARLOS GARRETT-GRAHAM B.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 MISSION GORGE RD STE 108
SAN DIEGO CA
92120-3425
US

IV. Provider business mailing address

1660 HOTEL CIR N STE 101
SAN DIEGO CA
92108-2801
US

V. Phone/Fax

Practice location:
  • Phone: 619-481-5200
  • Fax:
Mailing address:
  • Phone: 619-481-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: