Healthcare Provider Details

I. General information

NPI: 1073108205
Provider Name (Legal Business Name): SOFIA ABRIL PRENTISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOFIA TAYLOR ABRIL

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 AVENIDA PICO STE 104&201
SAN CLEMENTE CA
92673-6352
US

IV. Provider business mailing address

315 CENTENNIAL WAY
TUSTIN CA
92780-3714
US

V. Phone/Fax

Practice location:
  • Phone: 949-388-8788
  • Fax:
Mailing address:
  • Phone: 949-250-1101
  • Fax: 949-250-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: