Provider Demographics
NPI:1740848043
Name:SOTO, DESIREE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:SOTO
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 1:120 BROADWAY STE 204
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5705
Mailing Address - Country:US
Mailing Address - Phone:321-206-6560
Mailing Address - Fax:866-901-7203
Practice Address - Street 1:120 BROADWAY STE 204
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5705
Practice Address - Country:US
Practice Address - Phone:321-206-6560
Practice Address - Fax:866-901-7203
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator