Provider Demographics
NPI:1104866482
Name:SOTO GUERRERO, YAZMIN JOHANNA (MD)
Entity Type:Individual
Prefix:
First Name:YAZMIN
Middle Name:JOHANNA
Last Name:SOTO GUERRERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 DENBIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4427
Mailing Address - Country:US
Mailing Address - Phone:757-897-2141
Mailing Address - Fax:
Practice Address - Street 1:710 DENBIGH BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4427
Practice Address - Country:US
Practice Address - Phone:787-340-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201502105207R00000X
VA0101260290208M00000X, 207R00000X, 193400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No193400000XGroupSingle Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVL560F956Medicare UPIN
PRFG602AMedicare UPIN