MISS SONEMALA PHOMMATHA PA-C NPI 1720108830

NPI Information

NPI: 1720108830
Provider Name: MISS SONEMALA PHOMMATHA, PA-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
12605 E 16TH AVE
AURORA, CO
ZIP 80045
Phone: (720) 848-0000
Get Directions

MISS Sonemala Phommatha, PA-C is a surgical physician assistant in Aurora, CO. MISS Sonemala Phommatha, PA-C NPI is 1720108830. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

12605 E 16TH AVE
AURORA, CO
ZIP 80045-545
Phone: (720) 848-0000

The NPI 1720108830 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/30/2007 and was last updated on 10/22/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363A00000X	Physician Assistant		2374	COLORADO	No
2	363A00000X	Physician Assistant		PA05247	TEXAS	No
3	363AM0700X	Physician Assistant	Medical	2374	COLORADO	No
4	363AS0400X	Physician Assistant	Surgical	PA.0002374	COLORADO	Yes
5	363AS0400X	Physician Assistant	Surgical	2374	COLORADO	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8Y2613	OTHER	TEXAS	BLUE CROSS BLUE SHIELD
2	188291201	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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