Provider Demographics
NPI:1194313056
Name:PADILLA-MONTERO, SONIA (CMT)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:PADILLA-MONTERO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 LOHRMAN LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-1613
Mailing Address - Country:US
Mailing Address - Phone:707-206-5610
Mailing Address - Fax:
Practice Address - Street 1:6650 COMMERCE BLVD STE #24
Practice Address - Street 2:SUITE #24
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928
Practice Address - Country:US
Practice Address - Phone:707-206-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X, 174H00000X
251T00000X, 261QC1500X, 261QP3300X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA621399OtherNAICS