Provider Demographics
NPI:1528616570
Name:ANCHONDO, SOFIA ROSE NEICHERIL (PA-C)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:ROSE NEICHERIL
Last Name:ANCHONDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:ROSE
Other - Last Name:NEICHERIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11970 N CENTRAL EXPY STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3787
Mailing Address - Country:US
Mailing Address - Phone:214-382-5100
Mailing Address - Fax:
Practice Address - Street 1:11970 N CENTRAL EXPY STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3787
Practice Address - Country:US
Practice Address - Phone:214-382-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA13314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant