Healthcare Provider Details

I. General information

NPI: 1760306922
Provider Name (Legal Business Name): SUSANA SOTO GIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 DEERBERRY LN
LAKELAND FL
33810-2142
US

IV. Provider business mailing address

2012 DEERBERRY LN
LAKELAND FL
33810-2142
US

V. Phone/Fax

Practice location:
  • Phone: 786-350-5150
  • Fax:
Mailing address:
  • Phone: 786-350-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: