Provider Demographics
NPI:1528388691
Name:AMOS, SOPHIA IX
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:AMOS
Suffix:IX
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 1:3131 W 145TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3159
Mailing Address - Country:US
Mailing Address - Phone:323-392-9723
Mailing Address - Fax:
Practice Address - Street 1:3131 W 145TH ST APT 6
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3159
Practice Address - Country:US
Practice Address - Phone:323-392-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)