Provider Demographics
NPI:1710062773
Name:SIBAJA, SONIA ALEJANDRA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:ALEJANDRA
Last Name:SIBAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 SW 147TH AVE
Mailing Address - Street 2:# 8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4082
Mailing Address - Country:US
Mailing Address - Phone:305-348-1587
Mailing Address - Fax:305-348-1587
Practice Address - Street 1:2425 SW 147TH AVE
Practice Address - Street 2:# 8
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4082
Practice Address - Country:US
Practice Address - Phone:305-348-1587
Practice Address - Fax:305-348-1587
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 89693208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI49260Medicare UPIN