Healthcare Provider Details

I. General information

NPI: 1245984335
Provider Name (Legal Business Name): SOFLO ID LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 418
HIALEAH FL
33013-3835
US

IV. Provider business mailing address

PO BOX 630265
MIAMI FL
33163-0265
US

V. Phone/Fax

Practice location:
  • Phone: 305-962-8149
  • Fax:
Mailing address:
  • Phone: 305-962-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE L COHEN
Title or Position: OWNER
Credential: MD
Phone: 305-962-8149