Healthcare Provider Details

I. General information

NPI: 1891575064
Provider Name (Legal Business Name): CLAUDIA SOTO DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 SE 11TH ST
CAPE CORAL FL
33990-3675
US

IV. Provider business mailing address

1419 SE 11TH ST
CAPE CORAL FL
33990-3675
US

V. Phone/Fax

Practice location:
  • Phone: 239-544-0855
  • Fax:
Mailing address:
  • Phone: 239-544-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: