Provider Demographics
NPI:1427323526
Name:SOTO, REBEKAH JOY (MD)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JOY
Last Name: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 1:4150 WOODLANDS PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3495
Mailing Address - Country:US
Mailing Address - Phone:727-372-6760
Mailing Address - Fax:727-372-6808
Practice Address - Street 1:4150 WOODLANDS PKWY STE B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685
Practice Address - Country:US
Practice Address - Phone:727-372-6760
Practice Address - Fax:727-372-6808
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17231208000000X
FLME123193208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics