MEDICARE: SOFIA HASEROT

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	2255A2300X	Athletic Trainer
2	363A00000X	Physician Assistant	PA60895	CA

General Provider Information

NPI Number	:	1225626039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA HASEROT

Provider Business Mailing Address
First Line	:	150 N ROBERTSON BLVD STE 150
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2171
Country	:	US
Telephone Number	:	310-854-4995
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 N ROBERTSON BLVD STE 150
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2171
Country	:	US
Telephone Number	:	310-854-4995
Fax Number	:

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

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	06/24/2025

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Directions to “ SOFIA HASEROT ” Practice Location

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