Provider Demographics
NPI:1588679443
Name:SOTO-CORA, EDIBERTO (MD)
Entity type:Individual
Prefix:
First Name:EDIBERTO
Middle Name:
Last Name:SOTO-CORA
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 1:1139 CAPER RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7739
Mailing Address - Country:US
Mailing Address - Phone:915-591-7495
Mailing Address - Fax:915-592-5689
Practice Address - Street 1:1139 CAPER RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7739
Practice Address - Country:US
Practice Address - Phone:915-591-7495
Practice Address - Fax:915-592-5623
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0679207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123136704Medicaid
TX00J12GOtherBCBS
TX123136704Medicaid
E61979Medicare UPIN