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General NPI Number Information
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NPI Number | 1962281832
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Entity Type | Organization
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Legal Business Name | SOTO DIAZ PA
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 8207 FOREST CITY RD
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City | ORLANDO
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State | FL
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Zip | 32810-2354
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Country | US
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Telephone | 407-295-4861
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 SOLSTICE LOOP
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City | SANFORD
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State | FL
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Zip | 32771-0046
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Country | US
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Telephone | 787-642-6147
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAYMIELEE SOTO DIAZ
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Credential | PSYD
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Telephone | 787-642-6147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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