Individual
EDGARDO ANDRES SOTO RAMIREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
901 S NATIONAL AVE # PROF160, SPRINGFIELD, MO 65897-0027
(417) 836-8553
(417) 836-8554
Mailing address
901 S NATIONAL AVE # PROF160, SPRINGFIELD, MO 65897-0001
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZUA0012346141887
BLUE CRUZ AND BLUE SHIELD
PR
Enumeration date
06/05/2020
Last updated
06/05/2020
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