Healthcare Provider Details

I. General information

NPI: 1750140935
Provider Name (Legal Business Name): SOFI GELVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8702 SANTA MONICA BLVD
LOS ANGELES CA
90069-4508
US

IV. Provider business mailing address

8702 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90069-4508
US

V. Phone/Fax

Practice location:
  • Phone: 424-426-0441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: