Healthcare Provider Details

I. General information

NPI: 1093594095
Provider Name (Legal Business Name): SOPHIA CHELLAPPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44840 VALLEY CENTRAL WAY STE 102
LANCASTER CA
93536-7261
US

IV. Provider business mailing address

616 N KNIGHT DR
EDWARDS CA
93523-2735
US

V. Phone/Fax

Practice location:
  • Phone: 661-592-0701
  • Fax:
Mailing address:
  • Phone: 314-608-6389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: