Healthcare Provider Details

I. General information

NPI: 1639260201
Provider Name (Legal Business Name): SHERRY SOEFJE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 VISTA WAY SUITE D
OCEANSIDE CA
92056-4500
US

IV. Provider business mailing address

3998 VISTA WAY STE 100
OCEANSIDE CA
92056-4515
US

V. Phone/Fax

Practice location:
  • Phone: 760-806-1800
  • Fax: 760-806-1801
Mailing address:
  • Phone: 760-758-2222
  • Fax: 760-758-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA52993
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA52993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: