Provider Demographics
NPI:1982665477
Name:SOTO, WIGBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:WIGBERTO
Middle Name:
Last Name:SOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11914 ASTORIA
Mailing Address - Street 2:SUITE 440
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6064
Mailing Address - Country:US
Mailing Address - Phone:281-484-1106
Mailing Address - Fax:281-484-9415
Practice Address - Street 1:11914 ASTORIA
Practice Address - Street 2:SUITE 440
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6064
Practice Address - Country:US
Practice Address - Phone:281-484-1106
Practice Address - Fax:281-484-9415
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1072207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127003501Medicaid
G27608Medicare UPIN
TX127003501Medicaid
TX00542DMedicare PIN