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General NPI Number Information
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NPI Number | 1083961486
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Entity Type | Organization
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Legal Business Name | NORTH BAY MEDICAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 940 NE 79TH ST
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City | MIAMI
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State | FL
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Zip | 33138-4716
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Country | US
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Telephone | 305-672-7635
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Fax | 305-672-6201
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Provider Business Mailing Address
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Address Line | 940 NE 79TH ST
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City | MIAMI
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State | FL
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Zip | 33138-4716
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Country | US
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Telephone | 305-672-7635
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Fax | 305-672-6201
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAFAEL A SOTO
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Credential | MD
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Telephone | 305-672-7635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | ME26369
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License Number State | FL
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