Healthcare Provider Details

I. General information

NPI: 1871411041
Provider Name (Legal Business Name): SOFIA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 MADRUGA AVE STE 509
CORAL GABLES FL
33146-3048
US

IV. Provider business mailing address

2101 BRICKELL AVE APT 3402
MIAMI FL
33129-2127
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-9714
  • Fax: 786-536-9833
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: