Healthcare Provider Details

I. General information

NPI: 1750143392
Provider Name (Legal Business Name): SOPHIA RENE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 37TH ST UNIT 8
SAN DIEGO CA
92105-1045
US

IV. Provider business mailing address

4375 37TH ST UNIT 8
SAN DIEGO CA
92105-1045
US

V. Phone/Fax

Practice location:
  • Phone: 858-336-2229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70090291
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95027180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: