Provider Demographics
NPI:1093303182
Name:SOTO EXECUTIVE ENTERPRISE, LLC
Entity Type:Organization
Organization Name:SOTO EXECUTIVE ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:571-288-3440
Mailing Address - Street 1:5227 SPRING BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:VA
Mailing Address - Zip Code:22025-3048
Mailing Address - Country:US
Mailing Address - Phone:571-288-3440
Mailing Address - Fax:
Practice Address - Street 1:5227 SPRING BRANCH BLVD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:VA
Practice Address - Zip Code:22025-3048
Practice Address - Country:US
Practice Address - Phone:571-288-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty