Provider Demographics
NPI:1740024298
Name:PAPASTAMOS, SOFIA VALENCIA (PA)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:VALENCIA
Last Name:PAPASTAMOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2169 E VIMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1764
Mailing Address - Country:US
Mailing Address - Phone:801-864-4089
Mailing Address - Fax:
Practice Address - Street 1:2169 E VIMONT AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1764
Practice Address - Country:US
Practice Address - Phone:801-864-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty