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General NPI Number Information
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NPI Number | 1346365657
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Entity Type | Organization
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Legal Business Name | SOPHIA ROZOV DDS, INC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 8543 ROSEMEAD BLVD # D
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City | PICO RIVERA
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State | CA
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Zip | 90660-5427
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Country | US
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Telephone | 562-904-0400
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Fax | 562-904-1803
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Provider Business Mailing Address
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Address Line | 5640 ETIWANDA AVE # 5
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City | TARZANA
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State | CA
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Zip | 91356-2700
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Country | US
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Telephone | 562-904-0400
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Fax | 562-904-1803
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Authorized Official
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Title or Position | CEO
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Name | DR. SOPHIA ROZOV
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Credential | DDS
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Telephone | 562-904-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 45820
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License Number State | CA
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