Healthcare Provider Details

I. General information

NPI: 1912890468
Provider Name (Legal Business Name): ST SOPHIA MEDICAL STAFFING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 SW 57TH AVE
MIAMI FL
33144-3922
US

IV. Provider business mailing address

4760 SW 143RD AVE
MIAMI FL
33175-4329
US

V. Phone/Fax

Practice location:
  • Phone: 305-265-3239
  • Fax:
Mailing address:
  • Phone: 305-265-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DEYANIRA GUTIERREZ
Title or Position: ADMINISTRATOR
Credential: ARNP
Phone: 305-265-3239