Healthcare Provider Details

I. General information

NPI: 1821376492
Provider Name (Legal Business Name): SONIA BARBARA NODAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15107 VANOWEN ST
VAN NUYS CA
91405-4542
US

IV. Provider business mailing address

PO BOX 801742
SANTA CLARITA CA
91380-1742
US

V. Phone/Fax

Practice location:
  • Phone: 818-947-2918
  • Fax: 818-947-2920
Mailing address:
  • Phone: 818-947-2918
  • Fax: 818-947-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: