Healthcare Provider Details

I. General information

NPI: 1144766635
Provider Name (Legal Business Name): HEALTHY MINORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 3RD ST SUITE 106
ROCKLEDGE FL
32955-5744
US

IV. Provider business mailing address

6525 3RD ST SUITE 106
ROCKLEDGE FL
32955-5744
US

V. Phone/Fax

Practice location:
  • Phone: 850-766-2968
  • Fax:
Mailing address:
  • Phone: 850-766-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME94933
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME94933
License Number StateFL

VIII. Authorized Official

Name: DR. OLUYEMISI A SONOIKI
Title or Position: OWNER
Credential: M.D.
Phone: 850-766-2968