Healthcare Provider Details

I. General information

NPI: 1992669451
Provider Name (Legal Business Name): SOPHIA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 OLD CONEJO RD STE 200
THOUSAND OAKS CA
91320-2130
US

IV. Provider business mailing address

3095 OLD CONEJO RD STE 200
THOUSAND OAKS CA
91320-2130
US

V. Phone/Fax

Practice location:
  • Phone: 805-298-7034
  • Fax:
Mailing address:
  • Phone: 805-298-7034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: