MEDICARE: SERGIO FERNANDO SOTO 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	207RC0000X	Cardiovascular Disease Physician	2003-0507	NM
2	207RC0000X	Cardiovascular Disease Physician	37164	AZ

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	WCSKQ	OTHER	AZ	SUN HEALTH GROUP #

General Provider Information

NPI Number	:	1942204854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO FERNANDO SOTO MD

Provider Business Mailing Address
First Line	:	PO BOX 10880
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86304-0880
Country	:	US
Telephone Number	:	602-406-4786
Fax Number	:	916-636-4358

Provider Business Practice Location Address
First Line	:	7700 E FLORENTINE RD STE 206
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-2245
Country	:	US
Telephone Number	:	928-772-8217
Fax Number	:	928-442-8932

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	02/10/2025

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Directions to “ SERGIO FERNANDO SOTO MD” Practice Location

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