Healthcare Provider Details

I. General information

NPI: 1194666909
Provider Name (Legal Business Name): SOPHIA BERNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 BARNES RD STE 245
COLORADO SPRINGS CO
80917-1564
US

IV. Provider business mailing address

4440 BARNES RD STE 245
COLORADO SPRINGS CO
80917-1564
US

V. Phone/Fax

Practice location:
  • Phone: 719-600-9455
  • Fax: 719-466-9414
Mailing address:
  • Phone: 719-600-9455
  • Fax: 719-466-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: