Healthcare Provider Details

I. General information

NPI: 1780347393
Provider Name (Legal Business Name): SOPHIA ABDOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date: 04/05/2023
Reactivation Date: 07/18/2023

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

IV. Provider business mailing address

3175 DATA DR APT 2313
RANCHO CORDOVA CA
95670-6451
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7251
  • Fax:
Mailing address:
  • Phone: 702-496-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: