Healthcare Provider Details

I. General information

NPI: 1225610520
Provider Name (Legal Business Name): SOPHIE LIPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6957 N FIGUEROA ST
LOS ANGELES CA
90042-1245
US

IV. Provider business mailing address

832 N CROFT AVE APT 104
LOS ANGELES CA
90069-4269
US

V. Phone/Fax

Practice location:
  • Phone: 323-443-3175
  • Fax:
Mailing address:
  • Phone: 248-506-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: