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General NPI Number Information
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NPI Number | 1790810919
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Entity Type | Individual
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Provider Name | ILEANA CARIDAD SOTO RPH
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3289 SW 175TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33029-5584
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Country | US
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Telephone | 954-443-6010
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Fax | 786-513-4630
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Provider Business Mailing Address
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Address Line | 3289 SW 175TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33029-5584
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Country | US
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Telephone | 954-443-6010
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Fax | 786-513-4630
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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 | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | PS0025220
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License Number State | FL
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