Healthcare Provider Details

I. General information

NPI: 1427410919
Provider Name (Legal Business Name): CATALINA SOTO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 201-519-7456
  • Fax:
Mailing address:
  • Phone: 386-226-4590
  • Fax: 386-322-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS16237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: