MEDICARE: SONJA FARMER PA-C

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	363AM0700X	Medical Physician Assistant	PA18734	CA

General Provider Information

NPI Number	:	1720271406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJA FARMER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 13132
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90295-4132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4477 W 118TH ST STE 200
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2257
Country	:	US
Telephone Number	:	310-675-4440
Fax Number	:	310-675-2970

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

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	07/31/2008

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