MEDICARE: EDIBERTO SOTO-CORA M.D.

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

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
2	00J12G	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1588679443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDIBERTO SOTO-CORA M.D.

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	:	915-592-5689

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	01/29/2018

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