Healthcare Provider Details

I. General information

NPI: 1124064092
Provider Name (Legal Business Name): LUIS F SOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 HOUMA BLVD SUITE 107
METAIRIE LA
70006
US

IV. Provider business mailing address

4300 HOUMA BLVD SUITE 107
METAIRIE LA
70006
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-3500
  • Fax: 504-455-3006
Mailing address:
  • Phone: 504-455-3500
  • Fax: 504-455-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number06730R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number06730R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: