Provider Demographics
NPI:1194183319
Name:SOTO, ERIKA VANESSA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:VANESSA
Last Name:SOTO
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 CALIFORNIA RD APT 422
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417-9370
Mailing Address - Country:US
Mailing Address - Phone:830-352-4539
Mailing Address - Fax:
Practice Address - Street 1:250 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1341
Practice Address - Country:US
Practice Address - Phone:830-352-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0062322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer