Individual
SOFIA ANTONIA DE SOUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
510 W 11TH ST, MEDFORD, OR 97501-3555
(541) 613-0084
Mailing address
2981 STATE ST APT 71, MEDFORD, OR 97504-8451
(541) 613-0084
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
OR
Other
Enumeration date
01/26/2026
Last updated
01/26/2026
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