Provider Demographics
NPI:1881828507
Name:NIEVES-SOTO, ADA M
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:M
Last Name:NIEVES-SOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4302
Mailing Address - Country:US
Mailing Address - Phone:619-427-7390
Mailing Address - Fax:619-427-3907
Practice Address - Street 1:1325 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4302
Practice Address - Country:US
Practice Address - Phone:619-427-7390
Practice Address - Fax:619-427-3907
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 59651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist