Healthcare Provider Details

I. General information

NPI: 1215948674
Provider Name (Legal Business Name): RAFAEL AVELINO SOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 NE 79TH ST
MIAMI FL
33138-4742
US

IV. Provider business mailing address

1555 N TREASURE DR APT 407
NORTH BAY VILLAGE FL
33141-4192
US

V. Phone/Fax

Practice location:
  • Phone: 305-672-7635
  • Fax: 305-672-6201
Mailing address:
  • Phone: 786-461-0936
  • 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:
Title or Position:
Credential:
Phone: