Provider Demographics
NPI:1932481538
Name:IZMIRIAN, SONIA C (PHD)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:C
Last Name:IZMIRIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27999 E ROXBURY PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-7643
Mailing Address - Country:US
Mailing Address - Phone:818-531-8606
Mailing Address - Fax:
Practice Address - Street 1:1750 SW SKYLINE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2545
Practice Address - Country:US
Practice Address - Phone:503-894-9630
Practice Address - Fax:833-642-0439
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3858103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty