Provider Demographics
NPI:1447576970
Name:SOTO, CRISTOBAL RUBEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CRISTOBAL
Middle Name:RUBEN
Last Name:SOTO
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 433968
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92143-3968
Mailing Address - Country:US
Mailing Address - Phone:619-409-6900
Mailing Address - Fax:619-409-6901
Practice Address - Street 1:995 GATEWAY CENTER WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4500
Practice Address - Country:US
Practice Address - Phone:619-264-1934
Practice Address - Fax:619-264-1937
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA19031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant