Provider Demographics
NPI:1134277676
Name:SOFRA-WEISS, XANYA (PHD)
Entity type:Individual
Prefix:DR
First Name:XANYA
Middle Name:
Last Name:SOFRA-WEISS
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 1:7773 WAIKAPU LOOP
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3026
Mailing Address - Country:US
Mailing Address - Phone:808-222-2664
Mailing Address - Fax:808-395-0787
Practice Address - Street 1:7773 WAIKAPU LOOP
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3026
Practice Address - Country:US
Practice Address - Phone:808-222-2664
Practice Address - Fax:808-395-0787
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI520103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00507002Medicaid
HI00A004372OtherHMSA
HI00507002Medicaid