Provider Demographics
NPI:1720519945
Name:GAMEZ, SOPHIA SHANTEL (BSN, RN)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:SHANTEL
Last Name:GAMEZ
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SOLAR DR STE 250
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0144
Mailing Address - Country:US
Mailing Address - Phone:805-981-5115
Mailing Address - Fax:
Practice Address - Street 1:1701 SOLAR DR STE 250
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0144
Practice Address - Country:US
Practice Address - Phone:805-981-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95091596163WP0807X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent