Healthcare Provider Details

I. General information

NPI: 1265273551
Provider Name (Legal Business Name): SOPHIA MCGOWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 S HIGLEY RD
GILBERT AZ
85296-4771
US

IV. Provider business mailing address

1725 S CORONADO RD APT 3115
GILBERT AZ
85295-0091
US

V. Phone/Fax

Practice location:
  • Phone: 480-257-2700
  • Fax:
Mailing address:
  • Phone: 805-405-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11453
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: