Provider Demographics
NPI:1417370289
Name:SOHN, MAYRA ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ELIZABETH
Last Name:SOHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:ELIZABETH
Other - Last Name:HYUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1920 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1920 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4009
Practice Address - Country:US
Practice Address - Phone:323-725-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22768363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health