1639233265 NPI number — MARIA C SOTO-AGUILAR M D P A

Table of content: (NPI 1639233265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639233265 NPI number — MARIA C SOTO-AGUILAR M D P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA C SOTO-AGUILAR M D P A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639233265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14153 YOSEMITE DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34667-8060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-697-2150
Provider Business Mailing Address Fax Number:
727-863-4757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14153 YOSEMITE DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34667-8060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-697-2150
Provider Business Practice Location Address Fax Number:
727-863-4757
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOTO-AGUILAR
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
727-697-2150

Provider Taxonomy Codes

  • Taxonomy code: 207RA0201X , with the licence number:  ME79740 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RR0500X , with the licence number: ME79740 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 259231200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49628 . This is a "BLUECROSS BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 280536 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9255006-001 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7049127 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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