Provider Demographics
NPI:1568818789
Name:SOTO, IRMA HERNANDEZ (NP)
Entity Type:Individual
Prefix:MS
First Name:IRMA
Middle Name:HERNANDEZ
Last Name:SOTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IRMA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:15443 OLD CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-0909
Mailing Address - Country:US
Mailing Address - Phone:909-275-0416
Mailing Address - Fax:
Practice Address - Street 1:11285 MOUNTAIN VIEW AVE
Practice Address - Street 2:40
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3862
Practice Address - Country:US
Practice Address - Phone:909-558-5844
Practice Address - Fax:909-558-3168
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA814787163W00000X
CA95003989363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse