Provider Demographics
NPI:1275149213
Name:SOTO, ELVIS OLANDO
Entity Type:Individual
Prefix:MR
First Name:ELVIS
Middle Name:OLANDO
Last Name:SOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 PRESIDENTIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9816
Mailing Address - Country:US
Mailing Address - Phone:630-935-0629
Mailing Address - Fax:
Practice Address - Street 1:176 PRESIDENTIAL BLVD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9816
Practice Address - Country:US
Practice Address - Phone:630-935-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227000370225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist