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General NPI Number Information
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NPI Number | 1245984335
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Entity Type | Organization
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Legal Business Name | SOFLO ID LLC
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 777 E 25TH ST STE 418
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City | HIALEAH
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State | FL
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Zip | 33013-3835
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Country | US
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Telephone | 305-962-8149
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 630265
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City | MIAMI
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State | FL
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Zip | 33163-0265
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Country | US
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Telephone | 305-962-8149
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE L COHEN
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Credential | MD
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Telephone | 305-962-8149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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