Healthcare Provider Details

I. General information

NPI: 1205874146
Provider Name (Legal Business Name): RONDA SOTO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65-1267 KAWAIHAE RD
KAMUELA HI
96743-8406
US

IV. Provider business mailing address

74-5027A TOMI TOMI DRIVE
KAILUA KONA HI
96740-9626
US

V. Phone/Fax

Practice location:
  • Phone: 808-887-6410
  • Fax: 808-887-6429
Mailing address:
  • Phone: 808-987-4506
  • Fax: 808-326-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA0404453
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN-RX 145
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: