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NPI Code Detail

MEDICARE: ERMY J SOTO LND

MEDICARE: ERMY J SOTO LND
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
1133V00000XRegistered DietitianDT83820TX

General Provider Information

NPI Number : 1306125687
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERMY J SOTO LND
Provider Business Mailing Address
First Line : 3300 PEBBLEBROOK DR APT 82
Second Line :
City : SEABROOK
State : TX
Zip : 77586-6051
Country : US
Telephone Number : 787-677-9351
Fax Number :
Provider Business Practice Location Address
First Line : 7635 CANAL ST
Second Line :
City : HOUSTON
State : TX
Zip : 77012-1143
Country : US
Telephone Number : 713-660-1880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2011
Last Update Date : 12/22/2015

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