Provider Demographics
NPI:1689788754
Name:SOTO, ELAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14926
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87191-4926
Mailing Address - Country:US
Mailing Address - Phone:505-323-9004
Mailing Address - Fax:505-323-9004
Practice Address - Street 1:11000 SPAIN RD NE STE E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1895
Practice Address - Country:US
Practice Address - Phone:505-323-9004
Practice Address - Fax:505-323-9004
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0893103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM147316OtherVALUE OPTIONS
NM00JN07OtherBCBSNM
NM201047458OtherPRESBYTERIAN HEALTH PLAN
NM08387559Medicaid
NM343518201Medicare ID - Type UnspecifiedPERFORMING PROVIDER
NM08387559Medicaid