Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME26369 | FL |
NPI | 1215948674 |
---|---|
Provider Name | Dr. Rafael Avelino Soto |
First Address | North Bay Village, FL 33141-4192 |
Second Address | Miami, FL 33138-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 12/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056384600 | (05) | FL |
D60003 | (02) | FL |