MEDICARE: DR. SONNIA BALDERRAMA-OLIVA DR.PH, MBA, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	612630	TX
2	163WC1500X	Community Health Registered Nurse	612630	TX

General Provider Information

NPI Number	:	1235323890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONNIA BALDERRAMA-OLIVA DR.PH, MBA, RN

Provider Business Mailing Address
First Line	:	5416 COLUMBIA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-5120
Country	:	US
Telephone Number	:	214-476-7399
Fax Number	:	314-856-1554

Provider Business Practice Location Address
First Line	:	4049 EISENHOWER ST
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-1100
Country	:	US
Telephone Number	:	972-898-1217
Fax Number	:	314-856-1554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	11/10/2007

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