1720898083 NPI number — DR. SOPHIA ZEGA DACM, MACM, LAC

Table of content: DR. SOPHIA ZEGA DACM, MACM, LAC (NPI 1720898083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720898083 NPI number — DR. SOPHIA ZEGA DACM, MACM, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEGA
Provider First Name:
SOPHIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DACM, MACM, LAC
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1720898083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 NE FREMONT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97212-2027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-490-6430
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1171 MCVEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE OSWEGO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97034-4721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-490-6430
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2025

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:  AC223419 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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