Healthcare Provider Details

I. General information

NPI: 1104772698
Provider Name (Legal Business Name): RADIANT SOULS PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1821
US

IV. Provider business mailing address

1438 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1821
US

V. Phone/Fax

Practice location:
  • Phone: 505-308-8125
  • Fax: 505-219-3830
Mailing address:
  • Phone: 505-308-8125
  • Fax: 505-219-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SABINA ONWONGA
Title or Position: CEO
Credential: PMHNP-BC
Phone: 505-308-8125