Provider Demographics
NPI:1518525872
Name:NUNEZ RIVERA, SOFIA V
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:V
Last Name:NUNEZ RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2597 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3654
Mailing Address - Country:US
Mailing Address - Phone:787-602-4340
Mailing Address - Fax:
Practice Address - Street 1:240 CRANDON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1543
Practice Address - Country:US
Practice Address - Phone:786-464-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer