Provider Demographics
NPI:1861949885
Name:BLAQUIERE, SONYA L (BC-HIS)
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:L
Last Name:BLAQUIERE
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:MRS
Other - First Name:SONYA
Other - Middle Name:L
Other - Last Name:BLAQUIERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:A,AS BC-HIS
Mailing Address - Street 1:8060 W TROPICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4528
Mailing Address - Country:US
Mailing Address - Phone:702-656-8484
Mailing Address - Fax:702-656-4699
Practice Address - Street 1:8060 W TROPICAL PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4528
Practice Address - Country:US
Practice Address - Phone:702-656-8484
Practice Address - Fax:702-656-4699
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7616174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist