Provider Demographics
NPI:1255781977
Name:RIVERA -SOTO MEDICAL GROUP INTERNAL MEDICINE SPECIALIST
Entity type:Organization
Organization Name:RIVERA -SOTO MEDICAL GROUP INTERNAL MEDICINE SPECIALIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAZMIN
Authorized Official - Middle Name:JOHANNA
Authorized Official - Last Name:SOTO GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-340-8175
Mailing Address - Street 1:304 BLEVINS RUN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4188
Mailing Address - Country:US
Mailing Address - Phone:787-340-8175
Mailing Address - Fax:
Practice Address - Street 1:710 DENBIGH BLVD STE 7B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4427
Practice Address - Country:US
Practice Address - Phone:787-340-8175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty