Healthcare Provider Details

I. General information

NPI: 1003850025
Provider Name (Legal Business Name): MARISOL LUGARDO-SOTO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH AVENUE
MIAMI FL
33136
US

IV. Provider business mailing address

13770 SW 276TH STREET
HOMESTEAD FL
33032
US

V. Phone/Fax

Practice location:
  • Phone: 305-326-6543
  • Fax:
Mailing address:
  • Phone: 863-838-2407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberARNP9191301
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9191301
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: