MEDICARE: ALINA SOFIA VERDEJA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1316444813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALINA SOFIA VERDEJA

Provider Business Mailing Address
First Line	:	5701 SAN VICENTE ST
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2724
Country	:	US
Telephone Number	:	786-473-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 SAN VICENTE ST
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2724
Country	:	US
Telephone Number	:	786-473-2811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	04/11/2018

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