Provider Demographics
NPI:1639443740
Name:SOTO, JAIME (RRW)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:SOTO
Suffix:
Gender:M
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3684 KINGS WAY
Mailing Address - Street 2:APT. 1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6458
Mailing Address - Country:US
Mailing Address - Phone:916-370-6039
Mailing Address - Fax:
Practice Address - Street 1:4441 AUBURN BLVD.
Practice Address - Street 2:SUITE E
Practice Address - City:SACRAMENTO
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:95841
Practice Address - Country:UM
Practice Address - Phone:916-473-5764
Practice Address - Fax:916-473-5766
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW4576101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARW4576OtherREGISTERED RECOVERY WORKER