Healthcare Provider Details

I. General information

NPI: 1821911488
Provider Name (Legal Business Name): SOFIA BARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST UNIT A
INDIO CA
92201-6950
US

IV. Provider business mailing address

76738 NEW YORK AVE
PALM DESERT CA
92211-0913
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8632
  • Fax:
Mailing address:
  • Phone: 760-229-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: