Provider Demographics
NPI:1962281832
Name:SOTO DIAZ PA
Entity type:Organization
Organization Name:SOTO DIAZ PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYMIELEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-642-6147
Mailing Address - Street 1:1210 SOLSTICE LOOP
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-0046
Mailing Address - Country:US
Mailing Address - Phone:787-642-6147
Mailing Address - Fax:
Practice Address - Street 1:8207 FOREST CITY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-2354
Practice Address - Country:US
Practice Address - Phone:407-295-4861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty