Provider Demographics
NPI:1760222665
Name:SOTO SEDA, JESUS JOEL
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:JOEL
Last Name:SOTO SEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 CARDINAL CT
Mailing Address - Street 2:
Mailing Address - City:POINCIANA
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4423
Mailing Address - Country:US
Mailing Address - Phone:689-244-9623
Mailing Address - Fax:
Practice Address - Street 1:476 CARDINAL CT
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-4423
Practice Address - Country:US
Practice Address - Phone:689-244-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician