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General NPI Number Information
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NPI Number | 1639526338
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Entity Type | Individual
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Provider Name | SOFIA KENNEDY PRIETO M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 3601 4TH ST # MS 6211
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City | LUBBOCK
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State | TX
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Zip | 79430-6211
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Country | US
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Telephone | 806-743-3150
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 4TH ST # MS 6211
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City | LUBBOCK
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State | TX
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Zip | 79430-6211
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Country | US
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Telephone | 210-381-1657
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | BP10056140
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | T8021
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License Number State | TX
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