Provider Demographics
NPI:1699988303
Name:GOROSPE, SONNY DOMINGUEZ (RPT,RN)
Entity type:Individual
Prefix:
First Name:SONNY
Middle Name:DOMINGUEZ
Last Name:GOROSPE
Suffix:
Gender:M
Credentials:RPT,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 ALOKEE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2218
Mailing Address - Country:US
Mailing Address - Phone:407-322-2487
Mailing Address - Fax:
Practice Address - Street 1:527 ALOKEE CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2218
Practice Address - Country:US
Practice Address - Phone:407-322-2487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8787171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor