Provider Demographics
NPI:1558993709
Name:SOTO, ASHANTY (RDN)
Entity Type:Individual
Prefix:MRS
First Name:ASHANTY
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:ASHANTY
Other - Middle Name:KIABETH
Other - Last Name:SAMANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:853 FAIRVIEW AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6694
Mailing Address - Country:US
Mailing Address - Phone:626-618-3421
Mailing Address - Fax:
Practice Address - Street 1:853 FAIRVIEW AVE APT 12
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6694
Practice Address - Country:US
Practice Address - Phone:626-618-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86148183133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty