Provider Demographics
NPI:1639260201
Name:SOEFJE, SHERRY (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:SOEFJE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 VISTA WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4515
Mailing Address - Country:US
Mailing Address - Phone:760-758-2222
Mailing Address - Fax:760-758-2022
Practice Address - Street 1:3998 VISTA WAY
Practice Address - Street 2:SUITE D
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4500
Practice Address - Country:US
Practice Address - Phone:760-806-1800
Practice Address - Fax:760-806-1801
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA529932084P0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV14446OtherNEVADA STATE BOARD OF MEDICAL EXAMINERS
NVCS25002OtherBOARD OF PHARMACY
CA00A529930Medicaid
NVCS25002OtherBOARD OF PHARMACY
CA00A529930Medicaid