Provider Demographics
NPI:1417585142
Name:SOTO FEIJOO, RAUL (SA-C)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:SOTO FEIJOO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 W 11TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6433
Mailing Address - Country:US
Mailing Address - Phone:786-486-9041
Mailing Address - Fax:
Practice Address - Street 1:6433 W 11TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6433
Practice Address - Country:US
Practice Address - Phone:786-486-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20-164246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant