Provider Demographics
NPI:1316621550
Name:BRECHART, SOPHIA MAXINE
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:MAXINE
Last Name:BRECHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6442 E EVANS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-9605
Mailing Address - Country:US
Mailing Address - Phone:916-673-7417
Mailing Address - Fax:
Practice Address - Street 1:1040 CRATER LAKE AVE STE C
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6295
Practice Address - Country:US
Practice Address - Phone:541-226-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9792174400000X
OR10248095174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist