Healthcare Provider Details

I. General information

NPI: 1710683438
Provider Name (Legal Business Name): SOFIA A. FUNES, DO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5961 N FALLS CIRCLE DR APT 401
LAUDERHILL FL
33319-6818
US

IV. Provider business mailing address

5961 N FALLS CIRCLE DR APT 401
LAUDERHILL FL
33319-6818
US

V. Phone/Fax

Practice location:
  • Phone: 352-615-2950
  • Fax:
Mailing address:
  • Phone: 352-615-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SOFIA A FUNES
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: DO
Phone: 352-615-2950