Healthcare Provider Details

I. General information

NPI: 1538617386
Provider Name (Legal Business Name): SOPHIA FIDAI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11721 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3674
US

IV. Provider business mailing address

11721 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3674
US

V. Phone/Fax

Practice location:
  • Phone: 562-949-4807
  • Fax:
Mailing address:
  • Phone: 562-949-4807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: