Provider Demographics
NPI:1710062773
Name:SIBAJA, SONIA ALEJANDRA (MD)
Entity type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:ALEJANDRA
Last Name:SIBAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3155 NW 82ND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1056
Mailing Address - Country:US
Mailing Address - Phone:305-591-2988
Mailing Address - Fax:305-348-1587
Practice Address - Street 1:3155 NW 82ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1056
Practice Address - Country:US
Practice Address - Phone:305-591-2988
Practice Address - Fax:305-348-1587
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 89693208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269832300Medicaid