Provider Demographics
NPI:1194479519
Name:SOTO, IRMA
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 HOLCOMB CT
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2390
Mailing Address - Country:US
Mailing Address - Phone:706-621-2351
Mailing Address - Fax:
Practice Address - Street 1:1171 HOLCOMB CT
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2390
Practice Address - Country:US
Practice Address - Phone:706-621-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies