Provider Demographics
NPI:1184223281
Name:SOTO MENDEZ, RICARDO JAVIER
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:JAVIER
Last Name:SOTO MENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 NW 106TH AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3122
Mailing Address - Country:US
Mailing Address - Phone:939-273-6929
Mailing Address - Fax:
Practice Address - Street 1:3520 OAKS WAY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-5391
Practice Address - Country:US
Practice Address - Phone:305-807-1909
Practice Address - Fax:305-307-0308
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst