Basic Information
| Provider Information | |||||||||
| NPI: | 1548996663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORBON | ||||||||
| FirstName: | SOFIA | ||||||||
| MiddleName: | FLORES | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PPS, APCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 W WEST COVINA PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269740770 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1215 W WEST COVINA PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269740770 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2022 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 11942 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.