SOPHEA PANN (NPI# 1629350236) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629350236 |
| Entity Type | Individual |
| Full Name | SOPHEA PANN |
| Credential | N.P. |
| Practice Address |
800 Scenic Dr Modesto CA 95350-6131 |
| Mailing Address |
3525 Faust Ave Long Beach CA 90808-2841 |
| Practice Telephone | 2095584600 |
| Mailing Telephone | 5629008913 |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2015-03-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 792247 | CA | Nursing Service Providers |
| Y | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
792247 | CA | Nursing Service Providers |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
22774 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
800 SCENIC DR |
| City | MODESTO |
| State | CA |
| Zip Code | 95350-6131 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669582557 | Kathleen Leatherbarrow | Nurse Practitioner | 800 Scenic Dr, Bldg 4, Modesto, CA 95350-6131 | 2006-08-30 |
| 1477112282 | Christopher Hastay | Nutritionist | 800 Scenic Dr, Modesto, CA 95350-6131 | 2019-06-06 |
| 1548829369 | Jamie Lee Spadoni | Nutritionist | 800 Scenic Dr, Modesto, CA 95350-6131 | 2019-06-06 |
| 1972169167 | Lucy Soto | Technician | 800 Scenic Dr, Modesto, CA 95350-6131 | 2019-05-14 |
| 1124682224 | Carlos Cervantes | Technician | 800 Scenic Dr, Modesto, CA 95350-6131 | 2019-04-24 |
| 1285297614 | Kirsten Lynn Jasek-rysdahl | Social Worker | 800 Scenic Dr, Modesto, CA 95350-6131 | 2019-04-22 |
| 1902469299 | Erica Pierce | Technician | 800 Scenic Dr, Modesto, CA 95350-6131 | 2019-04-22 |
| 1558924050 | Francine Jew | Case Manager/Care Coordinator | 800 Scenic Dr, Modesto, CA 95350-6131 | 2019-04-19 |
| 1659934149 | Ann Louise Salvi | Prevention Professional | 800 Scenic Dr, Modesto, CA 95350-6131 | 2019-04-19 |
| 1710540703 | Nanette Hovasine | Technician | 800 Scenic Dr, Modesto, CA 95350-6131 | 2019-04-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164020459 | Karina Montes Rodriguez | Case Manager/Care Coordinator | Cip 1540 Florida Ave, Suite 212, Modesto, CA 95350 | 2020-10-09 |
| 1134737315 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 2057 Tully Road, Suite A, Modesto, CA 95350 | 2020-07-14 |
| 1588211254 | Karla Junuen Toscano | Licensed Vocational Nurse | 1235 Mchenry Ave. Suites A&b, Modesto, CA 95350 | 2019-08-19 |
| 1831694769 | Loretta Myers-weber | Nurse Practitioner | 1510 Florida Ave Ste A, Modesto, CA 95350 | 2018-03-23 |
| 1720599632 | Coral Alejandra Amador | Counselor | 1700 Mchenry Village Way, Suite 11b, Modesto, CA 95350 | 2017-10-18 |
| 1053820522 | Pannu and Henne Dental Corp. | Dentist | 3219 Mc Henry Ave, Suite E, Modesto, CA 95350 | 2017-09-27 |
| 1346779709 | Kevin Sotelo | Behavior Technician | 2630 W Rumble Road, Modesto, CA 95350 | 2017-06-08 |
| 1255869566 | Hoa Xuan Phan | Family Medicine | 1441 Florida Ave Ste 200, Modesto, CA 95350 | 2017-05-31 |
| 1356881163 | Brady S Marshall | Dentist | 201 E. Orangeburg Avenue, Suite C, Modesto, CA 95350 | 2017-02-27 |
| 1750755476 | Caremore Health Plan | Nurse Practitioner | 1234 Mchenry Avenue, Modesto, CA 95350 | 2015-11-18 |
| Find all providers in zip 95350 | ||||
| Taxonomy Code | 163WP0808X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881239622 | Christian Buck | Registered Nurse | 4605 Via Altura, Modesto, CA 95357-0667 | 2019-11-15 |
| 1598287906 | Janet Vargas | Registered Nurse | 1312 Pecos Ave, Modesto, CA 95351-4728 | 2017-07-07 |
| 1871982199 | Celeste Lascano | Registered Nurse | 3001 Hahn Dr Apt 354, Modesto, CA 95350-6585 | 2015-01-12 |
| 1558520114 | Kim Dale Goodrum | Registered Nurse | 825 Palmilla Dr, Modesto, CA 95356-1152 | 2008-06-08 |
| 1902093909 | Gayle Patricia Ivy | Registered Nurse | 3909 Trillium Ave, Modesto, CA 95356-1319 | 2007-10-03 |
| 1871792952 | Mary Lynn Miller | Registered Nurse | 500 N 9th St Ste C, Modesto, CA 95350-5814 | 2007-07-17 |
| 1962523225 | Koni Del Nugent | Registered Nurse | 1912 Post Oak Dr, Modesto, CA 95354-1634 | 2007-04-03 |
| 1104946946 | Melissa Alane Sanchez | Registered Nurse | 1829 Savoie Way, Modesto, CA 95356-8947 | 2007-03-29 |
| 1922132802 | John Francis Gilmore | Registered Nurse | 920 12th Street, Modesto, CA 95354 | 2007-03-15 |
| 1710012489 | Keri Berbena Rodgers | Registered Nurse | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2007-02-22 |
| Find all providers in MODESTO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.