1194785253 NPI number — DR. SOPHIA CHRISTINE SWENSEN DOM, LMT

Table of content: MS. KIMBERLY ARRINGTON (NPI 1689380503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194785253 NPI number — DR. SOPHIA CHRISTINE SWENSEN DOM, LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWENSEN
Provider First Name:
SOPHIA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DOM, LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TREZZA
Provider Other First Name:
E. SOPHIA
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DOM, LMT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194785253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6915 CALLE ALMERIA NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87113-1093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-345-3708
Provider Business Mailing Address Fax Number:
505-344-9620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6915 CALLE ALMERIA NE
Provider Second Line Business Practice Location Address:
1620 INDIAN SCHOOL ROAD NE
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87113-1093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-345-9934
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  773 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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