Healthcare Provider Details

I. General information

NPI: 1033659941
Provider Name (Legal Business Name): SOFIA GABRIELLE BELTRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7614 PARKWAY DR APT 2P
LA MESA CA
91942-1735
US

IV. Provider business mailing address

7614 PARKWAY DR APT 2P
LA MESA CA
91942-1735
US

V. Phone/Fax

Practice location:
  • Phone: 650-477-6999
  • Fax:
Mailing address:
  • Phone: 650-477-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: