Provider Demographics
NPI:1225655038
Name:SOPHIES FERTILITY AND WELLNESS, INC.
Entity Type:Organization
Organization Name:SOPHIES FERTILITY AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-975-9130
Mailing Address - Street 1:17330 HAMLIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5418
Mailing Address - Country:US
Mailing Address - Phone:310-975-9130
Mailing Address - Fax:
Practice Address - Street 1:17330 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-5418
Practice Address - Country:US
Practice Address - Phone:310-975-9130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty