MEDICARE: DR. MARIA GAVANCHO SOTOMAYOR MD

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	207N00000X	Dermatology Physician	ME94010	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316912082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA GAVANCHO SOTOMAYOR MD

Provider Business Mailing Address
First Line	:	4919 MEMORIAL HWY STE 150
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-7516
Country	:	US
Telephone Number	:	813-333-1512
Fax Number	:	813-333-1561

Provider Business Practice Location Address
First Line	:	3622 MADACA LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2057
Country	:	US
Telephone Number	:	813-513-3643
Fax Number	:	813-605-5465

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	03/30/2022

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