Provider Demographics
NPI:1821212663
Name:DE SOTO, JAMES ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANTHONY
Last Name:DE SOTO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2175 ROSALINE AVE
Mailing Address - Street 2:MERCY MEDICAL CENTER MEDICAL STAFF OFFICE
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2509
Mailing Address - Country:US
Mailing Address - Phone:530-225-6127
Mailing Address - Fax:530-225-7283
Practice Address - Street 1:2175 ROSALINE AVE
Practice Address - Street 2:MERCY MEDICAL CENTER MEDICAL STAFF OFFICE
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2509
Practice Address - Country:US
Practice Address - Phone:530-225-6127
Practice Address - Fax:530-225-7283
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45903207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology