Healthcare Provider Details

I. General information

NPI: 1609702638
Provider Name (Legal Business Name): SOPHIA GABRIELLE MICHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 BROCKTON AVE
RIVERSIDE CA
92506-3835
US

IV. Provider business mailing address

19146 TRAIL RIDE CT
PERRIS CA
92570-6537
US

V. Phone/Fax

Practice location:
  • Phone: 951-779-1966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: