Provider Demographics
NPI:1548655640
Name:MOMIN, SONIKA (MD)
Entity type:Individual
Prefix:
First Name:SONIKA
Middle Name:
Last Name:MOMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-8940
Mailing Address - Fax:303-425-9259
Practice Address - Street 1:3 SUPERIOR DR STE 100B
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8653
Practice Address - Country:US
Practice Address - Phone:303-415-8940
Practice Address - Fax:303-425-9259
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6052207Q00000X
CODR.0067915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387030505Medicaid
TX387030504Medicaid