Provider Demographics
NPI:1710410394
Name:SOTO, BIANCA ALICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:ALICIA
Last Name:SOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 SAN LORENZO AVE STE 3230
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1448
Mailing Address - Country:US
Mailing Address - Phone:305-444-6882
Mailing Address - Fax:
Practice Address - Street 1:358 SAN LORENZO AVE STE 3230
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1448
Practice Address - Country:US
Practice Address - Phone:305-444-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME144923208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program