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General NPI Number Information
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NPI Number | 1548909302
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Entity Type | Individual
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Provider Name | FELICIA SOFYAN
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Gender | Female
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 909-260-8192
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 S BEVERLY GLEN BLVD APT 7
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City | LOS ANGELES
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State | CA
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Zip | 90024-6127
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Country | US
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Telephone | 909-260-8192
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 20174
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License Number State | CA
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