Provider Demographics
NPI:1255121588
Name:LOPEZ MOLINA, SOFIA
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:LOPEZ MOLINA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 CRANDON BOULEVARD
Mailing Address - Street 2:LAKE VILLA 2 APT 307
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2578
Mailing Address - Country:US
Mailing Address - Phone:786-354-0145
Mailing Address - Fax:
Practice Address - Street 1:731 CRANDON BLVD APT 307
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-2578
Practice Address - Country:US
Practice Address - Phone:786-354-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9120090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant