Healthcare Provider Details

I. General information

NPI: 1922966969
Provider Name (Legal Business Name): SOPHIA RENEE ALONZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10633 E APACHE TRL STE 106
APACHE JUNCTION AZ
85120-3383
US

IV. Provider business mailing address

10633 E APACHE TRL STE 106
APACHE JUNCTION AZ
85120-3383
US

V. Phone/Fax

Practice location:
  • Phone: 480-818-5305
  • Fax: 888-602-1073
Mailing address:
  • Phone: 480-818-5305
  • Fax: 888-602-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA16753
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: