Healthcare Provider Details

I. General information

NPI: 1447080684
Provider Name (Legal Business Name): SOPHIA JANE GAYTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 FREDERICK ST APT 2
VENICE CA
90291-6109
US

IV. Provider business mailing address

1032 FREDERICK ST APT 2
VENICE CA
90291-6109
US

V. Phone/Fax

Practice location:
  • Phone: 310-944-4721
  • Fax:
Mailing address:
  • Phone: 310-944-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95041964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: