1750609442 NPI number — DR. MARICEL ZAYAS SOTO D.O

Table of content: DR. MARICEL ZAYAS SOTO D.O (NPI 1750609442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750609442 NPI number — DR. MARICEL ZAYAS SOTO D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTO
Provider First Name:
MARICEL
Provider Middle Name:
ZAYAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZAYAS
Provider Other First Name:
MARICEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750609442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1355 S INTERNATIONAL PKWY STE 1451
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32746-1694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-333-9888
Provider Business Mailing Address Fax Number:
407-333-9444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 S INTERNATIONAL PKWY STE 1451
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-1694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-333-9888
Provider Business Practice Location Address Fax Number:
407-333-9444
Provider Enumeration Date:
05/06/2010

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: 207R00000X , with the licence number:  0102203049 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: OS14969 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OS14969 . This is a "FL MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0102203049 . This is a "VA MEDICAL LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 100201300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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