Healthcare Provider Details

I. General information

NPI: 1558285809
Provider Name (Legal Business Name): SONIYA MATHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9078 GRAMERCY DR APT 98
SAN DIEGO CA
92123-2360
US

IV. Provider business mailing address

9078 GRAMERCY DR APT 98
SAN DIEGO CA
92123-2360
US

V. Phone/Fax

Practice location:
  • Phone: 619-214-0808
  • Fax:
Mailing address:
  • Phone: 619-214-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95351126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: