Provider Demographics
NPI:1437715950
Name:SOTO, VICTOR A (N/A)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:A
Last Name:SOTO
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:MR
Other - First Name:VICTOR
Other - Middle Name:A
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 N SUNOL DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-1429
Mailing Address - Country:US
Mailing Address - Phone:323-768-2513
Mailing Address - Fax:
Practice Address - Street 1:133 N SUNOL DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-1429
Practice Address - Country:US
Practice Address - Phone:323-768-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker