MEDICARE: SOFIA POMA PHD

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	103T00000X	Psychologist	PPY389	FL

General Provider Information

NPI Number	:	1801619341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA POMA PHD

Provider Business Mailing Address
First Line	:	700 NE 25TH ST APT 1003
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-5407
Country	:	US
Telephone Number	:	305-799-7832
Fax Number	:

Provider Business Practice Location Address
First Line	:	3390 MARY ST STE 116
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-5255
Country	:	US
Telephone Number	:	305-799-7832
Fax Number	:

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

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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Directions to “ SOFIA POMA PHD” Practice Location

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