1801030408 NPI number — EDGARDO SOTO DE LA ROSA M.D.

Table of content: KATE FELTER PA-C (NPI 1194033738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801030408 NPI number — EDGARDO SOTO DE LA ROSA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTO DE LA ROSA
Provider First Name:
EDGARDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1801030408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4235 KINGS HWY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33980-8421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4235 KINGS HWY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33980-8421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-613-1777
Provider Business Practice Location Address Fax Number:
941-613-1779
Provider Enumeration Date:
04/27/2009

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: 207RP1001X , with the licence number:  115041 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X , with the licence number: 115041 , 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: 009369200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14Q6Z . This is a "BCBSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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