Healthcare Provider Details

I. General information

NPI: 1932391067
Provider Name (Legal Business Name): SONIA CEBALLOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY #300
LAS VEGAS NV
89128-0443
US

IV. Provider business mailing address

8502 VERDE PARK CIR
LAS VEGAS NV
89129-2231
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-3547
  • Fax: 702-307-2204
Mailing address:
  • Phone: 951-288-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number13633
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA103960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: