Healthcare Provider Details

I. General information

NPI: 1346001328
Provider Name (Legal Business Name): SOFIA HERRERA SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CORBETT DR
FORT COLLINS CO
80528-9579
US

IV. Provider business mailing address

713 ROCKY RD
FORT COLLINS CO
80521-3025
US

V. Phone/Fax

Practice location:
  • Phone: 970-207-4857
  • Fax: 970-207-4885
Mailing address:
  • Phone: 970-317-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09930080
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: