Healthcare Provider Details

I. General information

NPI: 1386218436
Provider Name (Legal Business Name): SOPHIA BILLS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 KILROY AIRPORT WAY
LONG BEACH CA
90806-2494
US

IV. Provider business mailing address

PO BOX 2141
RANCHO SANTA FE CA
92067-2141
US

V. Phone/Fax

Practice location:
  • Phone: 213-731-1530
  • Fax:
Mailing address:
  • Phone: 442-888-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: