1568281764 NPI number — MA SOPHIA PATRICE PLATON IGNACIO

Table of content: MA SOPHIA PATRICE PLATON IGNACIO (NPI 1568281764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568281764 NPI number — MA SOPHIA PATRICE PLATON IGNACIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IGNACIO
Provider First Name:
MA SOPHIA PATRICE
Provider Middle Name:
PLATON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IGNACIO
Provider Other First Name:
ESPIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568281764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8324 REGENTS RD UNIT 2O
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92122-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-965-3835
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3878 RUFFIN RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-795-9925
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2024

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com