Provider Demographics
NPI:1194744177
Name:TOVAR, SONIA Y (FNP-C, MSM)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:Y
Last Name:TOVAR
Suffix:
Gender:F
Credentials:FNP-C, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 E HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-0000
Mailing Address - Country:US
Mailing Address - Phone:909-623-7799
Mailing Address - Fax:909-623-0663
Practice Address - Street 1:1019 E HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-0000
Practice Address - Country:US
Practice Address - Phone:909-623-7799
Practice Address - Fax:909-623-0663
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12356363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0123560Medicaid