MEDICARE: ISRAEL SOTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	0-17-8251	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154676740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISRAEL SOTO

Provider Business Mailing Address
First Line	:	9600 NW 25TH ST STE PH
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33172-1416
Country	:	US
Telephone Number	:	305-597-3861
Fax Number	:	305-597-3863

Provider Business Practice Location Address
First Line	:	9600 NW 25TH ST STE PH
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33172-1416
Country	:	US
Telephone Number	:	305-597-3861
Fax Number	:	305-597-3863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	09/18/2019

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Directions to “ ISRAEL SOTO ” Practice Location

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