Healthcare Provider Details

I. General information

NPI: 1588980346
Provider Name (Legal Business Name): SONIA ISABEL MILLAN PINZON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CYPRESS EDGE DR STE 207
PALM COAST FL
32164-8454
US

IV. Provider business mailing address

120 CYPRESS EDGE DR STE 207
PALM COAST FL
32164-8454
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-1910
  • Fax: 386-586-4411
Mailing address:
  • Phone: 386-586-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME119542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: