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NPI Code Detail

MEDICARE: SOPHIA MARIE DAVIES

MEDICARE: SOPHIA MARIE DAVIES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1730815853
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA MARIE DAVIES
Provider Business Mailing Address
First Line : 5415 SW WESTGATE DR
Second Line :
City : PORTLAND
State : OR
Zip : 97221-2409
Country : US
Telephone Number : 503-645-3581
Fax Number :
Provider Business Practice Location Address
First Line : 5240 NE ELAM YOUNG PKWY
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-6437
Country : US
Telephone Number : 503-846-4555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2022
Last Update Date : 07/29/2022

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