=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801619341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOFIA POMA PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2024
-----------------------------------------------------
Last Update Date | 11/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3390 MARY ST STE 116
-----------------------------------------------------
City | COCONUT GROVE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33133-5255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-799-7832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 NE 25TH ST APT 1003
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33137-5407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-799-7832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PPY389
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------