Provider Demographics
NPI:1174716690
Name:GARCIA-SOTO, MARIBEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
Last Name:GARCIA-SOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:603 W 115TH ST
Mailing Address - Street 2:#183
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7722
Mailing Address - Country:US
Mailing Address - Phone:212-368-4259
Mailing Address - Fax:212-368-0664
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-901-8297
Practice Address - Fax:718-901-8704
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192537-1207QA0401X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01904049Medicaid
NYH11142Medicare UPIN