Basic Information
| Provider Information | |||||||||
| NPI: | 1932175924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRINIS | ||||||||
| FirstName: | SOPHIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10881 SAN JOSE BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042603022 | ||||||||
| FaxNumber: | 9042603947 | ||||||||
| Practice Location | |||||||||
| Address1: | 1895 KINGSLEY AVE. | ||||||||
| Address2: | 903 | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046448353 | ||||||||
| FaxNumber: | 9046448289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD179632 | OR | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 036-126522 | IL | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD424500 | PA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | ME140593 | FL | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 291173 | MA | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.