Provider Demographics
NPI:1740381417
Name:SO, AFRICA S (MD)
Entity Type:Individual
Prefix:
First Name:AFRICA
Middle Name:S
Last Name:SO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 E VALENCIA MESA DR
Mailing Address - Street 2:#100
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835
Mailing Address - Country:US
Mailing Address - Phone:714-525-4185
Mailing Address - Fax:714-525-4185
Practice Address - Street 1:100 E VALENCIA MESA DR
Practice Address - Street 2:#100
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-525-4185
Practice Address - Fax:714-525-7321
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA347710208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A347710Medicare UPIN