MEDICARE: ESTIVALIS SOTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1184559965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTIVALIS SOTO

Provider Business Mailing Address
First Line	:	1318 VOLUNTEER DR
Second Line	:
City	:	BRUNSWICK
State	:	MD
Zip	:	21716-9705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 THOMAS JOHNSON DR STE A
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4371
Country	:	US
Telephone Number	:	240-651-5280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ ESTIVALIS SOTO ” Practice Location

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