Healthcare Provider Details

I. General information

NPI: 1881610210
Provider Name (Legal Business Name): SONIA PILLAR MADRAZO-RICO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 LAKE UNDERHILL ROAD SUITE 200
ORLANDO FL
32822
US

IV. Provider business mailing address

7975 LAKE UNDERHILL ROAD SUITE 200
ORLANDO FL
32822
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6830
  • Fax: 407-303-6839
Mailing address:
  • Phone: 407-303-6830
  • Fax: 407-303-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 58693
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0058693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: