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General NPI Number Information
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NPI Number | 1043425911
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Entity Type | Individual
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Provider Name | SONYA COOPER L.M.T #5343
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Gender | Female
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 45 DEREK JAMES DR
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City | EDGEWOOD
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State | NM
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Zip | 87015-9707
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Country | US
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Telephone | 505-217-5168
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Fax |
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Provider Business Mailing Address
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Address Line | 10255 JARASH PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3317
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Country | US
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Telephone | 505-217-5168
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5343
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License Number State | NM
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