Provider Demographics
NPI:1982767158
Name:HASSELL, SOPHIA MARIA
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:MARIA
Last Name:HASSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SOPHIA
Other - Middle Name:MARIA
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3409 N GREEN GULCH CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745
Mailing Address - Country:US
Mailing Address - Phone:520-529-8304
Mailing Address - Fax:
Practice Address - Street 1:3409 N GREEN GULCH CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-529-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist