Basic Information
| Provider Information | |||||||||
| NPI: | 1174716690 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA-SOTO | ||||||||
| FirstName: | MARIBEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 603 W 115TH ST | ||||||||
| Address2: | #183 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100257722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123684259 | ||||||||
| FaxNumber: | 2123680664 | ||||||||
| Practice Location | |||||||||
| Address1: | 1276 FULTON AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104563402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189018297 | ||||||||
| FaxNumber: | 7189018704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 08/20/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0401X | 192537-1 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207QA0505X | 192537-1 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01904049 | 05 | NY | MEDICAID |