Provider Demographics
NPI:1548271455
Name:SOTO MORENO, LOURDES (MD)
Entity type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:
Last Name:SOTO MORENO
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 1:131 FRANKLIN HEALTH CMNS
Mailing Address - Street 2:STE A
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938
Mailing Address - Country:US
Mailing Address - Phone:207-778-0035
Mailing Address - Fax:207-778-6879
Practice Address - Street 1:131 FRANKLIN HEALTH CMNS
Practice Address - Street 2:STE A
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938
Practice Address - Country:US
Practice Address - Phone:207-778-0035
Practice Address - Fax:207-778-6879
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0142462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME338810099Medicaid
ME338810099Medicaid
MEBS3928857OtherDEA
G20900Medicare UPIN