Provider Demographics
NPI:1891138442
Name:DUBE, SOPHIA (MD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:DUBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21550 OXNARD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7108
Mailing Address - Country:US
Mailing Address - Phone:855-701-7955
Mailing Address - Fax:
Practice Address - Street 1:21550 OXNARD ST STE 200
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-7108
Practice Address - Country:US
Practice Address - Phone:855-701-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-14
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS76392084P0800X
CA1933142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry