Provider Demographics
NPI:1093197022
Name:SOTO, CHRISTIAN ERIC (MM, MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:ERIC
Last Name:SOTO
Suffix:
Gender:M
Credentials:MM, MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 HEATHER RIDGE CIR APT 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3348
Mailing Address - Country:US
Mailing Address - Phone:305-305-0926
Mailing Address - Fax:305-468-6560
Practice Address - Street 1:1858 N ALAFAYA TRL STE 207
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4754
Practice Address - Country:US
Practice Address - Phone:407-900-5313
Practice Address - Fax:888-972-5443
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7139235Z00000X
FLSA15234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist