MEDICARE: MARISOL SOTO JIMENEZ DDS

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	1223G0001X	General Practice Dentistry	6458444	ZZ

General Provider Information

NPI Number	:	1841056587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISOL SOTO JIMENEZ DDS

Provider Business Mailing Address
First Line	:	PO BOX 16230
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85349-6963
Country	:	US
Telephone Number	:	928-509-1279
Fax Number	:	928-361-2599

Provider Business Practice Location Address
First Line	:	4731 E UDALL LN
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85349
Country	:	US
Telephone Number	:	619-831-0437
Fax Number	:	619-785-3404

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

Provider Enumeration Date	:	02/21/2024
Last Update Date	:	03/23/2026

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