Provider Demographics
NPI:1720898083
Name:ZEGA, SOPHIA (DACM, MACM, LAC)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:ZEGA
Suffix:
Gender:F
Credentials:DACM, MACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 NE FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2027
Mailing Address - Country:US
Mailing Address - Phone:541-490-6430
Mailing Address - Fax:
Practice Address - Street 1:1171 MCVEY AVE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-4721
Practice Address - Country:US
Practice Address - Phone:541-490-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC223419171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist