Provider Demographics
NPI:1629191036
Name:SOTO, ANGIE (FP)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11432 W MADISEN ELLISE DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-6965
Mailing Address - Country:US
Mailing Address - Phone:602-435-9097
Mailing Address - Fax:
Practice Address - Street 1:11432 W MADISEN ELLISE DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-6965
Practice Address - Country:US
Practice Address - Phone:602-435-9097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ143110Medicaid