MEDICARE: MRS. SOFIA LAGO

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	235Z00000X	Speech-Language Pathologist	SZ5086	FL

General Provider Information

NPI Number	:	1992016315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SOFIA LAGO

Provider Business Mailing Address
First Line	:	7100 SW 99TH AVE STE 201
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-4668
Country	:	US
Telephone Number	:	305-491-1032
Fax Number	:	888-491-0809

Provider Business Practice Location Address
First Line	:	7100 SW 99TH AVE STE 201
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-4668
Country	:	US
Telephone Number	:	305-491-1032
Fax Number	:	888-491-0809

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

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	06/30/2010

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Directions to “ MRS. SOFIA LAGO ” Practice Location

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