Healthcare Provider Details

I. General information

NPI: 1225703895
Provider Name (Legal Business Name): SOPHIA ANGELICA MADRINAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8463 SW 137TH AVE
MIAMI FL
33183-4074
US

IV. Provider business mailing address

8463 SW 137TH AVE
MIAMI FL
33183-4074
US

V. Phone/Fax

Practice location:
  • Phone: 305-970-8013
  • Fax:
Mailing address:
  • Phone: 305-970-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: