Provider Demographics
NPI:1235022369
Name:SOTO AVILA, ROSA I
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:I
Last Name:SOTO AVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2117
Mailing Address - Country:US
Mailing Address - Phone:347-424-9867
Mailing Address - Fax:
Practice Address - Street 1:197 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2117
Practice Address - Country:US
Practice Address - Phone:347-424-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318978174N00000X
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN