Healthcare Provider Details

I. General information

NPI: 1639380215
Provider Name (Legal Business Name): SOPAGNA EAP-BRAJE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOPAGNA BRAJE PHD

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 02/09/2022
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 MOREHOUSE DR STE 330
SAN DIEGO CA
92121-4786
US

IV. Provider business mailing address

5405 MOREHOUSE DR STE 330
SAN DIEGO CA
92121-4786
US

V. Phone/Fax

Practice location:
  • Phone: 858-215-1588
  • Fax:
Mailing address:
  • Phone: 858-215-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29743
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: