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General NPI Number Information
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NPI Number | 1316621550
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Entity Type | Individual
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Provider Name | MS. SOPHIA MAXINE BRECHART
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Gender | Female
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1040 CRATER LAKE AVE STE C
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City | MEDFORD
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State | OR
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Zip | 97504-6295
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Country | US
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Telephone | 541-226-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 6442 E EVANS CREEK RD
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City | ROGUE RIVER
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State | OR
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Zip | 97537-9605
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Country | US
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Telephone | 916-673-7417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L9792
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10248095
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License Number State | OR
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