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NPI Code Detail

MEDICARE: SOPHIA CEULEMANS M.S

MEDICARE:   SOPHIA  CEULEMANS  M.S
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
1170300000XGenetic Counselor (M.S.)GC000621CA

General Provider Information

NPI Number : 1255728713
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA CEULEMANS M.S
Provider Business Mailing Address
First Line : 3020 CHILDRENS WAY # MC5031
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-4223
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7920 FROST ST
Second Line : STE 200
City : SAN DIEGO
State : CA
Zip : 92123-2736
Country : US
Telephone Number : 858-966-8583
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2015
Last Update Date : 04/24/2015

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Directions to “ SOPHIA CEULEMANS M.S” Practice Location

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