Provider Demographics
NPI:1902653942
Name:PEDRAZA RUBIANO, SONIA PATRICIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:PATRICIA
Last Name:PEDRAZA RUBIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N UNIVERSITY DR STE 113
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2039
Mailing Address - Country:US
Mailing Address - Phone:954-618-3258
Mailing Address - Fax:
Practice Address - Street 1:201 N UNIVERSITY DR STE 113
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2039
Practice Address - Country:US
Practice Address - Phone:954-618-3258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA105075225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist