Healthcare Provider Details

I. General information

NPI: 1982190336
Provider Name (Legal Business Name): SONIA MARILY CORTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S DILLARD ST
WINTER GARDEN FL
34787-3523
US

IV. Provider business mailing address

11735 CONSTANCE WAY
CLERMONT FL
34711-7877
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-0029
  • Fax: 407-358-5207
Mailing address:
  • Phone: 787-484-7961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: