Provider Demographics
NPI:1760506778
Name:SONTAG, DAVID (AP, DOM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SONTAG
Suffix:
Gender:M
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 TOWERSIDE TER APT 1207
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2239
Mailing Address - Country:US
Mailing Address - Phone:305-891-3444
Mailing Address - Fax:305-895-1877
Practice Address - Street 1:18110 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1606
Practice Address - Country:US
Practice Address - Phone:305-949-2990
Practice Address - Fax:305-949-2980
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNC575133N00000X
FLAP845171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133N00000XDietary & Nutritional Service ProvidersNutritionist