Provider Demographics
NPI:1790810919
Name:SOTO, ILEANA CARIDAD (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:CARIDAD
Last Name:SOTO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 SW 175TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5584
Mailing Address - Country:US
Mailing Address - Phone:954-443-6010
Mailing Address - Fax:786-513-4630
Practice Address - Street 1:3289 SW 175TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5584
Practice Address - Country:US
Practice Address - Phone:954-443-6010
Practice Address - Fax:786-513-4630
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0025220302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization