Provider Demographics
NPI:1215454046
Name:STOCKS, SOPHIA (DPM)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:STOCKS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3229 E MALAPAI DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4954
Mailing Address - Country:US
Mailing Address - Phone:281-650-4324
Mailing Address - Fax:
Practice Address - Street 1:1430 E MISSOURI AVE STE B150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2479
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-000958213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty