Provider Demographics
NPI:1053818054
Name:SOTO, MAYLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MAYLEEN
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 LORENALY DR STE G
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4332
Mailing Address - Country:US
Mailing Address - Phone:956-525-7310
Mailing Address - Fax:956-525-7258
Practice Address - Street 1:302 LORENALY DR STE G
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4332
Practice Address - Country:US
Practice Address - Phone:956-525-7310
Practice Address - Fax:956-525-7258
Is Sole Proprietor?:No
Enumeration Date:2018-04-07
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant