Provider Demographics
NPI:1336939354
Name:SOTO, MATHEW ANTHONY
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:ANTHONY
Last Name:SOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6290 W 24TH CT APT 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4344
Mailing Address - Country:US
Mailing Address - Phone:786-510-8725
Mailing Address - Fax:
Practice Address - Street 1:6290 W 24TH CT APT 105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4344
Practice Address - Country:US
Practice Address - Phone:786-510-8725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS300-541-03-084-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician