Provider Demographics
NPI:1215948674
Name:SOTO, RAFAEL AVELINO (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:AVELINO
Last Name:SOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 N TREASURE DR
Mailing Address - Street 2:APT 407
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4192
Mailing Address - Country:US
Mailing Address - Phone:786-461-0936
Mailing Address - Fax:305-672-6201
Practice Address - Street 1:940 NE 79TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4742
Practice Address - Country:US
Practice Address - Phone:305-672-7635
Practice Address - Fax:305-672-6201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26369207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056384600Medicaid
FLD60003Medicare UPIN
FL056384600Medicaid