Provider Demographics
NPI:1407356041
Name:RAZO, SOFIA ELEAN
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:ELEAN
Last Name:RAZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 SW 119TH AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7991
Mailing Address - Country:US
Mailing Address - Phone:619-228-3361
Mailing Address - Fax:
Practice Address - Street 1:10737 S PRESERVE WAY APT 107
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6557
Practice Address - Country:US
Practice Address - Phone:619-228-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician