Healthcare Provider Details

I. General information

NPI: 1407694417
Provider Name (Legal Business Name): MARIA SOFIA CONDOMI ALCORTA RN/RNFA/P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 LUENGA AVE
CORAL GABLES FL
33146-2822
US

IV. Provider business mailing address

416 LUENGA AVE
CORAL GABLES FL
33146-2822
US

V. Phone/Fax

Practice location:
  • Phone: 305-922-4476
  • Fax:
Mailing address:
  • Phone: 305-922-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3058
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3058
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9659665
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number22-626
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN9659665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: