Healthcare Provider Details

I. General information

NPI: 1912524604
Provider Name (Legal Business Name): ASTRID DAYANARA SOTO-RUIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date: 09/14/2026
Reactivation Date: 09/29/2026

III. Provider practice location address

303 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2709
US

IV. Provider business mailing address

2211 LOMAS BLVD NE # 3
ALBUQUERQUE NM
87106-2719
US

V. Phone/Fax

Practice location:
  • Phone: 386-425-5600
  • Fax:
Mailing address:
  • Phone: 505-272-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME163530
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number163530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: