Healthcare Provider Details

I. General information

NPI: 1215454046
Provider Name (Legal Business Name): SOPHIA STOCKS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOPHIA LEE DPM

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E MISSOURI AVE STE B150
PHOENIX AZ
85014-2479
US

IV. Provider business mailing address

3229 E MALAPAI DR
PHOENIX AZ
85028-4954
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 281-650-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD-000958
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: