Healthcare Provider Details

I. General information

NPI: 1093197022
Provider Name (Legal Business Name): CHRISTIAN ERIC SOTO M.M., M.A., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 N ALAFAYA TRL STE 207
ORLANDO FL
32826-4754
US

IV. Provider business mailing address

10850 HEATHER RIDGE CIR APT 108
ORLANDO FL
32817-3348
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-5313
  • Fax: 888-972-5443
Mailing address:
  • Phone: 305-305-0926
  • Fax: 305-468-6560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ7139
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA15234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: