Provider Demographics
NPI:1295874956
Name:MIRVISS, SOPHIA N (MD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:N
Last Name:MIRVISS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3000 COLBY ST
Mailing Address - Street 2:STE 201
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2058
Mailing Address - Country:US
Mailing Address - Phone:415-876-5762
Mailing Address - Fax:415-876-4538
Practice Address - Street 1:3000 COLBY ST
Practice Address - Street 2:STE 201
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2058
Practice Address - Country:US
Practice Address - Phone:415-920-2700
Practice Address - Fax:415-920-2705
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-04-19
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Provider Licenses
StateLicense IDTaxonomies
CAG67981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG67981Medicare UPIN