Healthcare Provider Details

I. General information

NPI: 1720096795
Provider Name (Legal Business Name): SHERRIE SONOMURA MPH RD CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 VICTORIA ST APT 703
HONOLULU HI
96814-1450
US

IV. Provider business mailing address

1221 VICTORIA ST APT 703
HONOLULU HI
96814-1450
US

V. Phone/Fax

Practice location:
  • Phone: 415-793-5679
  • Fax:
Mailing address:
  • Phone: 415-793-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-188
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number813064
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: