Provider Demographics
NPI:1376508879
Name:SOTO, ALICIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:L
Last Name:SOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13 PECK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2308
Mailing Address - Country:US
Mailing Address - Phone:203-239-4627
Mailing Address - Fax:203-234-8533
Practice Address - Street 1:13 PECK ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2308
Practice Address - Country:US
Practice Address - Phone:203-239-4627
Practice Address - Fax:203-234-8533
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT043445208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT137650889Medicaid
CT137650889Medicaid