MEDICARE: AILENE SOPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1538875943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILENE SOPER

Provider Business Mailing Address
First Line	:	1248 MARSEILLE DR APT 5
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-2858
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1248 MARSEILLE DR APT 5
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-2858
Country	:	US
Telephone Number	:	512-903-8736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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Directions to “ AILENE SOPER ” Practice Location

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