Provider Demographics
NPI:1457045155
Name:DEVORE, SOPHIA LEEANA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:LEEANA
Last Name:DEVORE
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 1:615 E 3RD ST UNIT 206B
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1906
Mailing Address - Country:US
Mailing Address - Phone:614-359-7069
Mailing Address - Fax:
Practice Address - Street 1:615 E 3RD ST UNIT 206B
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1906
Practice Address - Country:US
Practice Address - Phone:614-359-7069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program