Healthcare Provider Details

I. General information

NPI: 1609408723
Provider Name (Legal Business Name): SOPHIA ANN DANIELS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA ANN BLAIR

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024178950
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: