Most Relevant Information
Provider Data
| NPI Number: | 1003526237 |
| Provider Name: | IAN SOPHIE |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/29/2022 |
| Last Updated: | 06/22/2023 |
Provider Practice Location
131B STONY CIRCLE
SUITE 1200
SANTA ROSA
CA
95401
Practice Location Phone/Fax
| Phone: | 7075767700 |
| Fax: |
Provider Mailing Location
401 ROLAND WAY STE 100
OAKLAND
CA
946212034
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |