Healthcare Provider Details

I. General information

NPI: 1790690055
Provider Name (Legal Business Name): DARA SOPHIA LA MADRID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 9TH ST STE 205
DURANGO CO
81301-5446
US

IV. Provider business mailing address

2002 E RIVER RD APT P9
TUCSON AZ
85718-6563
US

V. Phone/Fax

Practice location:
  • Phone: 970-239-3771
  • Fax:
Mailing address:
  • Phone: 970-844-9264
  • Fax:

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 StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: