Healthcare Provider Details

I. General information

NPI: 1417368176
Provider Name (Legal Business Name): SOPHIA LU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 2ND ST APT 511
OAKLAND CA
94607-4160
US

IV. Provider business mailing address

311 2ND ST APT 511
OAKLAND CA
94607-4160
US

V. Phone/Fax

Practice location:
  • Phone: 408-396-0288
  • Fax:
Mailing address:
  • Phone: 408-396-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105702
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: