Healthcare Provider Details

I. General information

NPI: 1174716690
Provider Name (Legal Business Name): MARIBEL GARCIA-SOTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FULTON AVE 3RD FLOOR
BRONX NY
10456-3402
US

IV. Provider business mailing address

603 W 115TH ST #183
NEW YORK NY
10025-7722
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8297
  • Fax: 718-901-8704
Mailing address:
  • Phone: 212-368-4259
  • Fax: 212-368-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number192537-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number192537-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: