Healthcare Provider Details

I. General information

NPI: 1841957800
Provider Name (Legal Business Name): SOPHIE SARAH RUZIC PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIE SCHMELL PSYD

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date: 02/08/2022
Reactivation Date: 12/05/2022

III. Provider practice location address

954 W FOOTHILL BLVD STE A
UPLAND CA
91786-3782
US

IV. Provider business mailing address

954 W FOOTHILL BLVD STE A
UPLAND CA
91786-3782
US

V. Phone/Fax

Practice location:
  • Phone: 909-946-4222
  • Fax: 909-946-8243
Mailing address:
  • Phone: 909-946-4222
  • Fax: 909-946-8243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY33815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: