Individual
SOPHIA SANTA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
8270 WILLOW OAKS CORPORATE DR, FAIRFAX, VA 22031-4511
(703) 921-2429
Mailing address
8270 WILLOW OAKS CORPORATE DR, FAIRFAX, VA 22031-4511
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202008174
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2202008174
—
VA
Enumeration date
02/20/2018
Last updated
02/20/2018
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