Healthcare Provider Details

I. General information

NPI: 1740024298
Provider Name (Legal Business Name): SOFIA VALENCIA PAPASTAMOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SE 192ND AVE STE 100
CAMAS WA
98607-6505
US

IV. Provider business mailing address

2169 E VIMONT AVE
SALT LAKE CITY UT
84109-1764
US

V. Phone/Fax

Practice location:
  • Phone: 360-556-4840
  • Fax:
Mailing address:
  • Phone: 801-864-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.61576451
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: