Healthcare Provider Details

I. General information

NPI: 1639233265
Provider Name (Legal Business Name): MARIA C SOTO-AGUILAR M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14153 YOSEMITE DR SUITE 201
HUDSON FL
34667-8060
US

IV. Provider business mailing address

14153 YOSEMITE DR SUITE 201
HUDSON FL
34667-8060
US

V. Phone/Fax

Practice location:
  • Phone: 727-697-2150
  • Fax: 727-863-4757
Mailing address:
  • Phone: 727-697-2150
  • Fax: 727-863-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberME79740
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME79740
License Number StateFL

VIII. Authorized Official

Name: DR. MARIA C SOTO-AGUILAR
Title or Position: OWNER
Credential: MD
Phone: 727-697-2150