Provider Demographics
NPI:1376254466
Name:SOTO, JUAN I
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:I
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 1:2103 N 5TH AVE TRLR 69
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3683
Mailing Address - Country:US
Mailing Address - Phone:509-947-1652
Mailing Address - Fax:
Practice Address - Street 1:2103 N 5TH AVE TRLR 69
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3683
Practice Address - Country:US
Practice Address - Phone:509-947-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter