Provider Demographics
NPI:1942204854
Name:SOTO, SERGIO FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:FERNANDO
Last Name:SOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SERGIO
Other - Middle Name:FERNANDO
Other - Last Name:SOTO-FIGUEROA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5987
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:7700 E FLORENTINE RD
Practice Address - Street 2:BLDG. B STE 206
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2245
Practice Address - Country:US
Practice Address - Phone:928-772-8217
Practice Address - Fax:928-442-8932
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0507207RC0000X
AZ37164207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ226148Medicaid
NM76485382Medicaid
AZWCSKQOtherSUN HEALTH GROUP #
AZWCSKQOtherSUN HEALTH GROUP #
AZZ117938Medicare PIN
NM349327502Medicare PIN
NM76485382Medicaid