Provider Demographics
NPI:1477380848
Name:SOTO FERNANDEZ, KAREN MARIA
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIA
Last Name:SOTO FERNANDEZ
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 1:495 N SEMORAN BLVD # 190
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3802
Mailing Address - Country:US
Mailing Address - Phone:407-861-7282
Mailing Address - Fax:
Practice Address - Street 1:495 N SEMORAN BLVD # 190
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3802
Practice Address - Country:US
Practice Address - Phone:407-861-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty