Healthcare Provider Details

I. General information

NPI: 1609622901
Provider Name (Legal Business Name): SOPHIA TRUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 MOUNTAIN VIEW AVE STE 225A
LOMA LINDA CA
92354-3867
US

IV. Provider business mailing address

11155 MOUNTAIN VIEW AVE STE 225A
LOMA LINDA CA
92354-3867
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-3927
  • Fax:
Mailing address:
  • Phone: 909-558-3927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: