Provider Demographics
NPI:1710912746
Name:DR SYLVIA ANA SOTO, PC
Entity Type:Organization
Organization Name:DR SYLVIA ANA SOTO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:325-486-9468
Mailing Address - Street 1:411 W CONCHO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6310
Mailing Address - Country:US
Mailing Address - Phone:325-486-9468
Mailing Address - Fax:325-653-6422
Practice Address - Street 1:411 W CONCHO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6310
Practice Address - Country:US
Practice Address - Phone:325-486-9468
Practice Address - Fax:325-653-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31147103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare ID - Type Unspecified
PENDINGMedicare UPIN