MEDICARE: SONJA ANGELIQUE MANN

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	207Q00000X	Family Medicine Physician	NP95027708	CA
2	207Q00000X	Family Medicine Physician	832827	NV
3	207Q00000X	Family Medicine Physician	298577	AZ

General Provider Information

NPI Number	:	1821674839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJA ANGELIQUE MANN

Provider Business Mailing Address
First Line	:	1535 E COLORADO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1513
Country	:	US
Telephone Number	:	702-956-7903
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 S HIGHWAY 95
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-8519
Country	:	US
Telephone Number	:	928-768-7113
Fax Number	:

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

Provider Enumeration Date	:	03/20/2021
Last Update Date	:	06/20/2025

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Directions to “ SONJA ANGELIQUE MANN ” Practice Location

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