Healthcare Provider Details

I. General information

NPI: 1528434362
Provider Name (Legal Business Name): SOFIA FISKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 I ST NW STE 800
WASHINGTON DC
20006-4088
US

IV. Provider business mailing address

130 SUTTER ST FL 2
SAN FRANCISCO CA
94104-4009
US

V. Phone/Fax

Practice location:
  • Phone: 202-660-0015
  • Fax: 202-660-0025
Mailing address:
  • Phone: 415-658-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA031576
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005859
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: