Healthcare Provider Details

I. General information

NPI: 1578267001
Provider Name (Legal Business Name): SOPHIA DHILLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 GUERNEVILLE RD STE 800
SANTA ROSA CA
95403-7228
US

IV. Provider business mailing address

2448 GUERNEVILLE RD STE 800
SANTA ROSA CA
95403-7228
US

V. Phone/Fax

Practice location:
  • Phone: 707-800-7744
  • Fax: 707-800-7799
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA205735
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA205735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: