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Individual

EDGARDO SOTO DE LA ROSA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4235 KINGS HWY, SUITE 103, PORT CHARLOTTE, FL 33980-8421
(941) 613-1777
(941) 613-1779
Mailing address
4235 KINGS HWY, SUITE 103, PORT CHARLOTTE, FL 33980-8421

Taxonomy

Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
115041
FL
207RP1001X
Pulmonary Disease Physician
Primary
115041
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009369200
FL
01
14Q6Z
BCBSFL
FL
Enumeration date
04/27/2009
Last updated
06/27/2017
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