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Individual

SOPHIA KHALIL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
201 CEDAR ST SE STE 5660, ALBUQUERQUE, NM 87106-4920
(505) 563-6565
Mailing address
PO BOX 2666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2021-0062
NM
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
01/15/2020
Last updated
09/10/2021
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