Provider Demographics
NPI:1326185513
Name:SOTO AYERS, JUANITA (MA(ED))
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:SOTO AYERS
Suffix:
Gender:F
Credentials:MA(ED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 W MONTEROSA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5238
Mailing Address - Country:US
Mailing Address - Phone:602-277-0709
Mailing Address - Fax:602-279-6535
Practice Address - Street 1:2 N 31ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-4849
Practice Address - Country:US
Practice Address - Phone:602-353-5220
Practice Address - Fax:602-353-5284
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program