Healthcare Provider Details

I. General information

NPI: 1336067636
Provider Name (Legal Business Name): SOPHIA WEIMER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37100 N GANTZEL RD STE 106
SAN TAN VALLEY AZ
85140-7350
US

IV. Provider business mailing address

37100 N GANTZEL RD STE 106
SAN TAN VALLEY AZ
85140-7350
US

V. Phone/Fax

Practice location:
  • Phone: 925-640-3210
  • Fax:
Mailing address:
  • Phone: 480-821-3600
  • Fax: 480-857-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12009
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: