Provider Demographics
NPI:1013658418
Name:CRESPO SOTO, HAYNIELIS
Entity type:Individual
Prefix:
First Name:HAYNIELIS
Middle Name:
Last Name:CRESPO SOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16361 SW 50TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5069
Mailing Address - Country:US
Mailing Address - Phone:786-731-5022
Mailing Address - Fax:
Practice Address - Street 1:16361 SW 50TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5069
Practice Address - Country:US
Practice Address - Phone:786-731-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-29274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist