Basic Information
Provider Information | |||||||||
NPI: | 1245723501 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MAKNOJIA | ||||||||
FirstName: | SONIA | ||||||||
MiddleName: | ENEZ | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1330 MAC ARTHUR DR APT 1902 | ||||||||
Address2: |   | ||||||||
City: | CARROLLTON | ||||||||
State: | TX | ||||||||
PostalCode: | 750076433 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4698889326 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 16620 N US HIGHWAY 281 STE 300 | ||||||||
Address2: |   | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782322679 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2103091405 | ||||||||
FaxNumber: | 2106884596 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/12/2018 | ||||||||
LastUpdateDate: | 05/16/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | AP136108 | TX | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.