Healthcare Provider Details

I. General information

NPI: 1962372474
Provider Name (Legal Business Name): SOFIA MICHAILIDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 E CARTWRIGHT AVE
FRESNO CA
93725-9385
US

IV. Provider business mailing address

2568 E WATERFORD AVE
FRESNO CA
93720-4627
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-7111
  • Fax:
Mailing address:
  • Phone: 559-710-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number755115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: