Provider Demographics
NPI:1750609442
Name:SOTO, MARICEL ZAYAS (DO)
Entity type:Individual
Prefix:DR
First Name:MARICEL
Middle Name:ZAYAS
Last Name:SOTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MARICEL
Other - Middle Name:
Other - Last Name:ZAYAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1355 S INTERNATIONAL PKWY STE 1451
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1694
Mailing Address - Country:US
Mailing Address - Phone:407-333-9888
Mailing Address - Fax:407-333-9444
Practice Address - Street 1:1355 S INTERNATIONAL PKWY STE 1451
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1694
Practice Address - Country:US
Practice Address - Phone:407-333-9888
Practice Address - Fax:407-333-9444
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203049207R00000X
FLOS14969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS14969OtherFL MEDICAL LICENSE
VA0102203049OtherVA MEDICAL LICENSE