Provider Demographics
NPI:1104072248
Name:PASSALACQUA, SONJA (LM)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:PASSALACQUA
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61A DOUBLE ARROW RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-8117
Mailing Address - Country:US
Mailing Address - Phone:505-982-4904
Mailing Address - Fax:505-982-2373
Practice Address - Street 1:61A DOUBLE ARROW RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-8117
Practice Address - Country:US
Practice Address - Phone:505-982-4904
Practice Address - Fax:505-982-2373
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96338 R175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay