Provider Demographics
NPI:1437895026
Name:SOTO, MARY TERESA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TERESA
Last Name:SOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S JOHNSON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-1231
Mailing Address - Country:US
Mailing Address - Phone:407-840-4217
Mailing Address - Fax:
Practice Address - Street 1:121 S JOHNSON ST APT 3
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-1231
Practice Address - Country:US
Practice Address - Phone:407-840-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide