Provider Demographics
NPI:1760233589
Name:SOTO, LABRONZE ANDRE
Entity Type:Individual
Prefix:
First Name:LABRONZE
Middle Name:ANDRE
Last Name:SOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1257
Mailing Address - Country:US
Mailing Address - Phone:304-646-5069
Mailing Address - Fax:
Practice Address - Street 1:487 NORTH AVE
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1257
Practice Address - Country:US
Practice Address - Phone:304-646-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant