Provider Demographics
NPI:1083233357
Name:SOFKA, MEGAN SUSANNE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SUSANNE
Last Name:SOFKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 SUPERSTITION DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7514
Mailing Address - Country:US
Mailing Address - Phone:505-306-7437
Mailing Address - Fax:
Practice Address - Street 1:1208 PRINCETON DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3019
Practice Address - Country:US
Practice Address - Phone:505-346-7656
Practice Address - Fax:505-485-0560
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMDO2023-0413204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program