Healthcare Provider Details

I. General information

NPI: 1083961486
Provider Name (Legal Business Name): NORTH BAY MEDICAL ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 NE 79TH ST
MIAMI FL
33138-4716
US

IV. Provider business mailing address

940 NE 79TH ST
MIAMI FL
33138-4716
US

V. Phone/Fax

Practice location:
  • Phone: 305-672-7635
  • Fax: 305-672-6201
Mailing address:
  • Phone: 305-672-7635
  • Fax: 305-672-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME26369
License Number StateFL

VIII. Authorized Official

Name: RAFAEL A SOTO
Title or Position: PRESIDENT
Credential: MD
Phone: 305-672-7635