Basic Information
| Provider Information | |||||||||
| NPI: | 1902164551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANGWALA | ||||||||
| FirstName: | SOPHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 731 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805390731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708009330 | ||||||||
| FaxNumber: | 7209274301 | ||||||||
| Practice Location | |||||||||
| Address1: | 3451 MOUNTAIN LION DR | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805378817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708009330 | ||||||||
| FaxNumber: | 7209274301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2012 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | 58655 | CO | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207N00000X | 58655 | CO | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 13994197 | 01 | CAQH | OTHER |