Provider Demographics
NPI:1205874146
Name:SOTO, RONDA (NP)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74-5027A TOMI TOMI DRIVE
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9626
Mailing Address - Country:US
Mailing Address - Phone:808-987-4506
Mailing Address - Fax:808-326-9071
Practice Address - Street 1:65-1267 KAWAIHAE RD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8406
Practice Address - Country:US
Practice Address - Phone:808-887-6410
Practice Address - Fax:808-887-6429
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIA0404453363LA2200X
HIAPRN-RX 145363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000024896-3OtherHMSA OFFICE SITE
HI00A024896-1OtherHMSA LIFE CARE CENTER
HI00B024896-9OtherHMSA KONA HOSPITAL LTC
HI560616-03Medicaid
HI560616-02Medicaid
HIH101043OtherMEDICARE
HI560616-01Medicaid
HIHMSAOther74-5027A TOMI TOMI DRIVE
HI56061605Medicaid
HI00D0248965OtherHMSA
HI3866653OtherUNIVERSITY HEALTH ALLIANC
HI57614OtherMEDICARE
HI560616-01Medicaid
HI560616-02Medicaid