Provider Demographics
NPI:1245291640
Name:SOTO, MARIA VICTORIA (DO)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:VICTORIA
Last Name:SOTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 BETHEL ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2611
Mailing Address - Country:US
Mailing Address - Phone:614-457-5477
Mailing Address - Fax:614-459-8636
Practice Address - Street 1:1365 BETHEL ROAD
Practice Address - Street 2:DOCTORS ON BETHEL ROAD
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2611
Practice Address - Country:US
Practice Address - Phone:614-457-5477
Practice Address - Fax:614-459-8636
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2045236Medicaid
OH2045236Medicaid
G65255Medicare UPIN