Healthcare Provider Details

I. General information

NPI: 1376458117
Provider Name (Legal Business Name): SOPHIA LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11575 CITY HALL PROMENADE
MIRAMAR FL
33025-7582
US

IV. Provider business mailing address

300 GRANELLO AVE APT 856
CORAL GABLES FL
33146-1950
US

V. Phone/Fax

Practice location:
  • Phone: 786-859-0774
  • Fax: 833-333-1556
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8725
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: