Healthcare Provider Details

I. General information

NPI: 1184223281
Provider Name (Legal Business Name): RICARDO JAVIER SOTO MENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 OAKS WAY
POMPANO BEACH FL
33069-5391
US

IV. Provider business mailing address

947 NW 106TH AVENUE CIR
MIAMI FL
33172-3122
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-1909
  • Fax: 305-307-0308
Mailing address:
  • Phone: 939-273-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: