Provider Demographics
NPI:1912753104
Name:JOHNSON, SONJI ROSE
Entity type:Individual
Prefix:MRS
First Name:SONJI
Middle Name:ROSE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E CAMELBACK RD
Mailing Address - Street 2:STE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4165
Mailing Address - Country:US
Mailing Address - Phone:619-796-3141
Mailing Address - Fax:602-241-2860
Practice Address - Street 1:1801 E CAMELBACK RD.
Practice Address - Street 2:STE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4165
Practice Address - Country:US
Practice Address - Phone:619-796-3141
Practice Address - Fax:602-241-2860
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6865FA7CBEFA190246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy