Healthcare Provider Details

I. General information

NPI: 1063346914
Provider Name (Legal Business Name): SOPHIE VALERIA FREDERICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 DOUGLAS ST
WEST SACRAMENTO CA
95605-2074
US

IV. Provider business mailing address

3800 61ST ST
SACRAMENTO CA
95820-2421
US

V. Phone/Fax

Practice location:
  • Phone: 805-814-0692
  • Fax:
Mailing address:
  • Phone: 218-340-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: