Provider Demographics
NPI:1033557301
Name:SOTO, ERIC (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SOTO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3871 VALLE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2917
Mailing Address - Country:US
Mailing Address - Phone:702-541-4577
Mailing Address - Fax:
Practice Address - Street 1:107 NORUMBEGA DR
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016
Practice Address - Country:US
Practice Address - Phone:702-788-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1110524363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical