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General NPI Number Information
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NPI Number | 1366085763
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Entity Type | Individual
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Provider Name | SIMON ANDREW SOTO IDC
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Gender | Male
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Dates
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Enumeration Date | 10/18/2019
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | NAVAL SUPPORT ACTIVITY SOUDA BAY
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City | CHANIA
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State | CRETE
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Zip | 73100
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Country | GR
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Telephone | 282-102-1590
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 814 BOX 19
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City | FPO
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State | AE
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Zip | 09266-0001
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Country | US
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Telephone | 314-266-1583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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