Provider Demographics
NPI:1326477969
Name:LA SOTA, BRYAN
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:LA SOTA
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 1:27240 TURNBERRY LN
Mailing Address - Street 2:SUITE 240
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1029
Mailing Address - Country:US
Mailing Address - Phone:661-254-7108
Mailing Address - Fax:
Practice Address - Street 1:27240 TURNBERRY LN
Practice Address - Street 2:SUITE 240
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1029
Practice Address - Country:US
Practice Address - Phone:661-254-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst