Provider Demographics
NPI:1588710297
Name:SOTO, JACQUELINE (MEDICAL TECHNOLOGIST)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:MEDICAL TECHNOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 W 74TH ST
Mailing Address - Street 2:APT.101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6833
Mailing Address - Country:US
Mailing Address - Phone:305-575-7000
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:PATHOLOGY & LABORATORY MEDICINE SERVICE (113)
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-575-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN28898246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist