MEDICARE: SOPHIA SABLAN PSY.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	103TC0700X	Clinical Psychologist	40635	TX

General Provider Information

NPI Number	:	1346898855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA SABLAN PSY.D.

Provider Business Mailing Address
First Line	:	5001 N PIEDRAS ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79930-4210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 N PIEDRAS ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79930-4210
Country	:	US
Telephone Number	:	915-564-6100
Fax Number	:

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

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	04/09/2026

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