Provider Demographics
NPI:1104881044
Name:SOTO, JAVIER J (MD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:J
Last Name:SOTO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N SYKES CREEK PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3488
Mailing Address - Country:US
Mailing Address - Phone:321-459-1192
Mailing Address - Fax:321-459-2304
Practice Address - Street 1:150 N SYKES CREEK PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3488
Practice Address - Country:US
Practice Address - Phone:321-459-1192
Practice Address - Fax:321-459-2304
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90297207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270057300Medicaid
FL124507700Medicaid
FL270057300Medicaid