Healthcare Provider Details

I. General information

NPI: 1760944391
Provider Name (Legal Business Name): SOFIA KLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 FLETCHER PKWY STE 105
LA MESA CA
91942-3132
US

IV. Provider business mailing address

2377 DURAZNITOS RD
RAMONA CA
92065-3604
US

V. Phone/Fax

Practice location:
  • Phone: 619-403-5700
  • Fax:
Mailing address:
  • Phone: 760-315-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A21355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: