Sophea Pann, RN

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

792247 Issued in CA

Practice address

800 Scenic Dr
Modesto, CA 95350-6131

Phone

(209) 558-4600

NPI assigned

Sep 9, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Stanislaus

  • Community/Behavioral Health Agency
  • Ceres, CA
  • NPI 1205969904
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1629350236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1904 RICHLAND AVE BLDG C-2",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953074562",
            "telephone_number": "209-525-5079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SCENIC DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506131",
            "telephone_number": "209-558-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANN",
        "first_name": "SOPHEA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-09",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "792247",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "22774",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "792247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hemal Aditya Pandya Mehta, DDS
• Vith Pang, PHARMD
• Juan Pangan
• Angela Pangilinan
• Rosalie Irene Paniagua Gamaza
• Divya Pannala, M.D.
• Jeremy Pannell II
• Melody Pannell, LCSW
• Pannu and Henne Dental Corp.
• Sumeet Pannu

• Psychiatric/Mental Health Registered Nurse in Modesto, CA
• Providers in Modesto, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.