Basic Information
Provider Information
NPI: 1033557301
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOTO
FirstName: ERIC
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3871 VALLE VISTA DR
Address2:  
City: CHINO HILLS
State: CA
PostalCode: 917092917
CountryCode: US
TelephoneNumber: 7025414577
FaxNumber:  
Practice Location
Address1: 107 NORUMBEGA DR
Address2:  
City: MONROVIA
State: CA
PostalCode: 91016
CountryCode: US
TelephoneNumber: 7027887307
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/10/2013
LastUpdateDate: 01/15/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X1110524CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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