Healthcare Provider Details

I. General information

NPI: 1295585701
Provider Name (Legal Business Name): SOFIA DYER-DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 COTTONWOOD ST STE 14
WOODLAND CA
95695-3603
US

IV. Provider business mailing address

1618 ALHAMBRA BLVD UNIT 162431
SACRAMENTO CA
95816-7699
US

V. Phone/Fax

Practice location:
  • Phone: 530-759-3192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number141669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: