Healthcare Provider Details

I. General information

NPI: 1295874956
Provider Name (Legal Business Name): SOPHIA N MIRVISS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLBY ST STE 201
BERKELEY CA
94705-2058
US

IV. Provider business mailing address

3000 COLBY ST STE 201
BERKELEY CA
94705-2058
US

V. Phone/Fax

Practice location:
  • Phone: 415-920-2700
  • Fax: 415-920-2705
Mailing address:
  • Phone: 415-876-5762
  • Fax: 415-876-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG67981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: