Provider Demographics
NPI:1639233265
Name:MARIA C SOTO-AGUILAR M D P A
Entity Type:Organization
Organization Name:MARIA C SOTO-AGUILAR M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOTO-AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-697-2150
Mailing Address - Street 1:14153 YOSEMITE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-8060
Mailing Address - Country:US
Mailing Address - Phone:727-697-2150
Mailing Address - Fax:727-863-4757
Practice Address - Street 1:14153 YOSEMITE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-8060
Practice Address - Country:US
Practice Address - Phone:727-697-2150
Practice Address - Fax:727-863-4757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79740207RA0201X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259231200Medicaid
FL49628OtherBLUECROSS BLUE SHIELD FL
FL280536OtherAVMED
FL9255006-001OtherCIGNA
FL7049127OtherAETNA
FL49628Medicare PIN
FL030004706Medicare PIN
FLF21594Medicare UPIN