MEDICARE: SOPHIA HOFFMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1134946833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA HOFFMAN

Provider Business Mailing Address
First Line	:	7875 S UNION AVE APT 1207
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-2750
Country	:	US
Telephone Number	:	832-515-4219
Fax Number	:

Provider Business Practice Location Address
First Line	:	7875 S UNION AVE APT 1207
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-2750
Country	:	US
Telephone Number	:	832-515-4219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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