Basic Information
| Provider Information | |||||||||
| NPI: | 1306090642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOTO GRANT | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | LILIA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4910 E ASHLAN AVE STE 118 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937263021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592564474 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1014 SAN JUAN AVE | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932211312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595927300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2008 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 90322 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.