Healthcare Provider Details

I. General information

NPI: 1215611769
Provider Name (Legal Business Name): SOFIA NEVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 S VERMONT AVE
LOS ANGELES CA
90007-4203
US

IV. Provider business mailing address

3031 S VERMONT AVE
LOS ANGELES CA
90007-3033
US

V. Phone/Fax

Practice location:
  • Phone: 323-240-7133
  • Fax:
Mailing address:
  • Phone: 323-697-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: