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General NPI Number Information
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NPI Number | 1417873340
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Entity Type | Individual
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Provider Name | MRS. SOPHIA RUCKER-GEFFRARD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 3490 NW 200TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1786
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Country | US
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Telephone | 305-793-0440
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Fax | 877-770-1197
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Provider Business Mailing Address
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Address Line | 3490 NW 200TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1786
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Country | US
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Telephone | 305-793-0440
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Fax | 877-770-1197
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | SO-11-1164-GH
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License Number State | FL
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