Healthcare Provider Details

I. General information

NPI: 1043919632
Provider Name (Legal Business Name): SOPHIA DIGIOVANNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W AVENUE P4
PALMDALE CA
93551-3743
US

IV. Provider business mailing address

525 W AVENUE P4
PALMDALE CA
93551-3743
US

V. Phone/Fax

Practice location:
  • Phone: 661-272-9996
  • Fax: 661-272-0438
Mailing address:
  • Phone: 661-272-9996
  • Fax: 661-272-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT160574
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: