Individual
MRS. SOPHIA FORMOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
733 CEDAR ST, GARBERVILLE, CA 95542-3201
(707) 923-3921
Mailing address
PO BOX 92, WHITETHORN, CA 95589-0092
(415) 490-8308
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
53577
CA
Other
Enumeration date
07/17/2025
Last updated
07/17/2025
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