Provider Demographics
NPI:1366479909
Name:SOTO, MARIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:SOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:LUISA
Other - Last Name:SOTO CARABALLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:700 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2527
Mailing Address - Country:US
Mailing Address - Phone:719-589-3696
Mailing Address - Fax:719-589-4901
Practice Address - Street 1:700 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2527
Practice Address - Country:US
Practice Address - Phone:719-589-3696
Practice Address - Fax:719-589-4901
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15158207Q00000X
CODR-45903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72408715Medicaid