Provider Demographics
NPI:1427445345
Name:SOTERIA MEDICAL, LLC
Entity type:Organization
Organization Name:SOTERIA MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:305-595-4447
Mailing Address - Street 1:9150 SW 87TH AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2319
Mailing Address - Country:US
Mailing Address - Phone:305-595-4447
Mailing Address - Fax:305-248-6320
Practice Address - Street 1:9150 SW 87TH AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2319
Practice Address - Country:US
Practice Address - Phone:305-595-4447
Practice Address - Fax:305-248-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2086850293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2086850OtherCLIA