Provider Demographics
NPI:1578240115
Name:CIENFUEGOS, SOPHIA ROSE
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ROSE
Last Name:CIENFUEGOS
Suffix:
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 1:10925 SOUTHERN HIGHLANDS PKWY APT 2063
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4316
Mailing Address - Country:US
Mailing Address - Phone:702-787-2866
Mailing Address - Fax:
Practice Address - Street 1:5980 S DURANGO DR STE 131
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1775
Practice Address - Country:US
Practice Address - Phone:888-505-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician