Healthcare Provider Details

I. General information

NPI: 1659510022
Provider Name (Legal Business Name): SONIA ISABEL AMBRIZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MCHENRY VILLAGE WAY
MODESTO CA
95350-4308
US

IV. Provider business mailing address

1600 N CARPENTER RD STE B
MODESTO CA
95351-1185
US

V. Phone/Fax

Practice location:
  • Phone: 209-550-5850
  • Fax:
Mailing address:
  • Phone: 209-550-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: