Healthcare Provider Details

I. General information

NPI: 1164085510
Provider Name (Legal Business Name): DIANA SOFIA SABOGAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 11/16/2022
Certification Date: 02/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 AVENTURA BLVD STE 245
AVENTURA FL
33180-3120
US

IV. Provider business mailing address

880 NW 13TH ST STE 300
BOCA RATON FL
33486-2342
US

V. Phone/Fax

Practice location:
  • Phone: 305-692-1080
  • Fax:
Mailing address:
  • Phone: 844-665-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: