Provider Demographics
NPI:1437225208
Name:HYZIN, SOPHIA MARY (PHD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARY
Last Name:HYZIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 E FOURTH ST
Mailing Address - Street 2:#230
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:949-858-3072
Mailing Address - Fax:949-858-3072
Practice Address - Street 1:1651 E FOURTH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:949-858-3072
Practice Address - Fax:949-858-3072
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13974103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R16806Medicare UPIN
CACP13974Medicare ID - Type Unspecified