Provider Demographics
NPI:1235144189
Name:EDIBERTO SOTO-CORA, M.D., P.A.
Entity Type:Organization
Organization Name:EDIBERTO SOTO-CORA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDIBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO-CORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-591-7495
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:STE. 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-771-6558
Practice Address - Street 1:1139 CAPER RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7739
Practice Address - Country:US
Practice Address - Phone:915-591-7495
Practice Address - Fax:915-592-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123136704Medicaid
TX00J12GOtherBCBS
TX00J12GMedicare ID - Type Unspecified