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General NPI Number Information
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NPI Number | 1417756636
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Entity Type | Individual
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Provider Name | SOPHIA JUAREZ
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Gender | Female
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 4545 FANUEL ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-2904
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Country | US
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Telephone | 858-200-6462
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Fax |
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Provider Business Mailing Address
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Address Line | 5150 GALT WAY
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City | SAN DIEGO
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State | CA
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Zip | 92117-1128
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Country | US
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Telephone | 858-200-6462
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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 | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 78792
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License Number State | CA
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