Provider Demographics
NPI:1962207795
Name:SORIA, AGUSTIN
Entity type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:
Last Name:SORIA
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 1:330 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6341
Mailing Address - Country:US
Mailing Address - Phone:786-856-7063
Mailing Address - Fax:
Practice Address - Street 1:20335 W COUNTRY CLUB DR APT 1410
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1622
Practice Address - Country:US
Practice Address - Phone:786-523-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician