Healthcare Provider Details

I. General information

NPI: 1508160813
Provider Name (Legal Business Name): DARIANA SOTO-REYES R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73D WINTHROP AVE
LAWRENCE MA
01843-3716
US

IV. Provider business mailing address

73D WINTHROP AVE
LAWRENCE MA
01843-3716
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-3017
  • Fax: 978-685-5612
Mailing address:
  • Phone: 978-686-3017
  • Fax: 978-685-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000003331
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: