Provider Demographics
NPI:1396714317
Name:PEREZ-SOTO, YARITZA (MD)
Entity type:Individual
Prefix:
First Name:YARITZA
Middle Name:
Last Name:PEREZ-SOTO
Suffix:
Gender:F
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:PO BOX 7518
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33911-7518
Mailing Address - Country:US
Mailing Address - Phone:239-931-7262
Mailing Address - Fax:239-931-7397
Practice Address - Street 1:11181 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 3050
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5738
Practice Address - Country:US
Practice Address - Phone:239-260-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34183208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008486800Medicaid
FL008486800Medicaid
I36091Medicare UPIN