MEDICARE: DR. SOPHIA DHILLON MD

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	A205735	CA
2	2084P0800X	Psychiatry Physician	A205735	CA

General Provider Information

NPI Number	:	1578267001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA DHILLON MD

Provider Business Mailing Address
First Line	:	2448 GUERNEVILLE RD STE 800
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-7228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2448 GUERNEVILLE RD STE 800
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-7228
Country	:	US
Telephone Number	:	707-800-7744
Fax Number	:	707-800-7799

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

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	05/31/2026

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