MEDICARE: EDIBERTO SOTO-CORA MD PA

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	207RC0000X	Cardiovascular Disease Physician	J0679	TX

General Provider Information

NPI Number	:	1508308412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDIBERTO SOTO-CORA MD PA

Provider Business Mailing Address
First Line	:	1139 CAPER RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-7739
Country	:	US
Telephone Number	:	915-591-7495
Fax Number	:	915-592-5623

Provider Business Practice Location Address
First Line	:	1139 CAPER RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-7739
Country	:	US
Telephone Number	:	915-591-7495
Fax Number	:	915-592-5623

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDIBERTO SOTO-CORA
Credential	:	MD
Telephone Number	:	915-591-7465

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	11/09/2016

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