1205874146 NPI number — RONDA SOTO NP

Table of content: RONDA SOTO NP (NPI 1205874146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205874146 NPI number — RONDA SOTO NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTO
Provider First Name:
RONDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

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:
1205874146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74-5027A TOMI TOMI DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96740-9626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-987-4506
Provider Business Mailing Address Fax Number:
808-326-9071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65-1267 KAWAIHAE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-887-6410
Provider Business Practice Location Address Fax Number:
808-887-6429
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  A0404453 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: APRN-RX 145 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000024896-3 . This is a "HMSA OFFICE SITE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A024896-1 . This is a "HMSA LIFE CARE CENTER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00B024896-9 . This is a "HMSA KONA HOSPITAL LTC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 560616-03 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 560616-02 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: H101043 . This is a "MEDICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 560616-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: HMSA . This is a "74-5027A TOMI TOMI DRIVE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 56061605 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00D0248965 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 3866653 . This is a "UNIVERSITY HEALTH ALLIANC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 57614 . This is a "MEDICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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