Provider Demographics
NPI:1639526338
Name:PRIETO, SOFIA KENNEDY (MD)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:KENNEDY
Last Name:PRIETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:TERESE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST # MS 6211
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-6211
Mailing Address - Country:US
Mailing Address - Phone:210-381-1657
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST # MS 6211
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-6211
Practice Address - Country:US
Practice Address - Phone:806-743-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10056140207R00000X
TXT8021207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine