Healthcare Provider Details

I. General information

NPI: 1811655111
Provider Name (Legal Business Name): SOPHIA COBLE HEREK RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA ANNE COBLE

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8912 VOLUNTEER LN
SACRAMENTO CA
95826-3221
US

IV. Provider business mailing address

15 PENDEGAST ST
WOODLAND CA
95695-4634
US

V. Phone/Fax

Practice location:
  • Phone: 916-344-0199
  • Fax:
Mailing address:
  • Phone: 530-863-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: