Provider Demographics
NPI:1649594474
Name:SOTO, MARIA THERESA (RN)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:THERESA
Last Name:SOTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W PARK WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2636
Mailing Address - Country:US
Mailing Address - Phone:714-290-3431
Mailing Address - Fax:
Practice Address - Street 1:2001 E ORANGETHORPE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6759
Practice Address - Country:US
Practice Address - Phone:714-524-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA757836163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0150193OtherMEDI-CAL