Provider Demographics
NPI:1093422396
Name:ANTONOVA, SOFIYA S (INTERPETR)
Entity Type:Individual
Prefix:
First Name:SOFIYA
Middle Name:S
Last Name:ANTONOVA
Suffix:
Gender:F
Credentials:INTERPETR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15216 116TH PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4607
Mailing Address - Country:US
Mailing Address - Phone:425-273-0817
Mailing Address - Fax:
Practice Address - Street 1:15216 116TH PL NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4607
Practice Address - Country:US
Practice Address - Phone:425-273-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604130098261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC55748OtherDSHS PROFESSIANAL INTERPRETER