Provider Demographics
NPI:1538403084
Name:MESGHENNA, SOPHIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:
Last Name:MESGHENNA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 MOORPARK ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1508
Mailing Address - Country:US
Mailing Address - Phone:619-756-8048
Mailing Address - Fax:
Practice Address - Street 1:1328 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-8501
Practice Address - Country:US
Practice Address - Phone:619-401-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-22
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine