Healthcare Provider Details

I. General information

NPI: 1366139990
Provider Name (Legal Business Name): DR. SOFIA PORTUONDO QUIRCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOFIA DANIELLE PORTUONDO

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

101 ALMERIA AVE
CORAL GABLES FL
33134-6008
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2273
  • Fax:
Mailing address:
  • Phone: 786-294-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME176760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: