MEDICARE: TAMRA 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	103K00000X	Behavior Analyst

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	:	1689095754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMRA SOTO

Provider Business Mailing Address
First Line	:	2626 GOLDEN POINCIANA PLACE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232
Country	:	US
Telephone Number	:	941-228-4745
Fax Number	:

Provider Business Practice Location Address
First Line	:	2526 GOLDEN POINCIANA PL
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-4253
Country	:	US
Telephone Number	:	941-228-4745
Fax Number	:

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

Provider Enumeration Date	:	12/17/2013
Last Update Date	:	12/17/2013

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Directions to “ TAMRA SOTO ” Practice Location

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