Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 192537-1 | NY |
Y | 207QA0505X | Family Doctor - Adult Medicine | 192537-1 | NY |
NPI | 1174716690 |
---|---|
Provider Name | Dr. Maribel Garcia-Soto |
First Address | New York, NY 10025-7722 |
Second Address | Bronx, NY 10456-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 20/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01904049 | (05) | NY |
H11142 | (02) | NY |