Healthcare Provider Details

I. General information

NPI: 1689508368
Provider Name (Legal Business Name): GENTLE PATH PRIMARY CARE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13120 SW 127TH CT
MIAMI FL
33186-7582
US

IV. Provider business mailing address

13120 SW 127TH CT
MIAMI FL
33186-7582
US

V. Phone/Fax

Practice location:
  • Phone: 786-719-2645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MAIDENLY LAZARA SOTOLONGO
Title or Position: OWNER
Credential: NP
Phone: 786-719-2645