Provider Demographics
NPI:1467278317
Name:CABAN-SOTO, LUIS G (DC)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:G
Last Name:CABAN-SOTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 DUNLAWTON AVE APT 907
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4762
Mailing Address - Country:US
Mailing Address - Phone:787-314-2527
Mailing Address - Fax:
Practice Address - Street 1:1205 MONUMENT RD STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6482
Practice Address - Country:US
Practice Address - Phone:904-594-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor