Healthcare Provider Details

I. General information

NPI: 1578383139
Provider Name (Legal Business Name): SOPHIA LORIE TUAZON MSN, RN, DNC, CWCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

361 BASSWOOD CMN UNIT 2
LIVERMORE CA
94551-6499
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 650-922-4613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number751461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: