Healthcare Provider Details

I. General information

NPI: 1427323526
Provider Name (Legal Business Name): REBEKAH JOY SOTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 WOODLANDS PKWY STE B
PALM HARBOR FL
34685
US

IV. Provider business mailing address

4150 WOODLANDS PKWY STE B
PALM HARBOR FL
34685-3495
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-6760
  • Fax: 727-372-6808
Mailing address:
  • Phone: 727-372-6760
  • Fax: 727-372-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17231
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME123193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: