Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 111101 | CA |
Y | 207RH0003X | Hematology & Oncology | 11410986-1205 | UT |
N | 207RH0003X | Hematology & Oncology | MD2017-0575 | NM |
N | 207RX0202X | Medical Oncology | 11410986-1205 | UT |
N | 207RX0202X | Medical Oncology | ME123384 | FL |
NPI | 1033435490 |
---|---|
Provider Name | Dr. Heloisa Prado Soares |
First Address | Salt Lake City, UT 84112-5550 |
Second Address | Salt Lake City, UT 84112-5550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2010 |
Last Update Date | 17/11/2021 |