Healthcare Provider Details

I. General information

NPI: 1083430052
Provider Name (Legal Business Name): SOPHIA MARIE HAMELINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST STE 423
SAN FRANCISCO CA
94114-1027
US

IV. Provider business mailing address

632 HAIGHT ST APT A
SAN FRANCISCO CA
94117-3305
US

V. Phone/Fax

Practice location:
  • Phone: 415-551-9758
  • Fax: 415-437-5434
Mailing address:
  • Phone: 810-730-8571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: