Provider Demographics
NPI:1083961486
Name:NORTH BAY MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:NORTH BAY MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-672-7635
Mailing Address - Street 1:940 NE 79TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4716
Mailing Address - Country:US
Mailing Address - Phone:305-672-7635
Mailing Address - Fax:305-672-6201
Practice Address - Street 1:940 NE 79TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4716
Practice Address - Country:US
Practice Address - Phone:305-672-7635
Practice Address - Fax:305-672-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26369207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1215948674OtherINDIVIDUAL NPI
FL1215948674OtherINDIVIDUAL NPI