Healthcare Provider Details

I. General information

NPI: 1326739038
Provider Name (Legal Business Name): SOFIYA KUPIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8733 LA PRADA DR
DALLAS TX
75228-5036
US

IV. Provider business mailing address

430 BUCKINGHAM RD APT 2022
RICHARDSON TX
75081-5767
US

V. Phone/Fax

Practice location:
  • Phone: 214-321-0156
  • Fax:
Mailing address:
  • Phone: 646-750-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number108603
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: