Provider Demographics
NPI:1972647964
Name:SOTO-GATES, JOSE ERNESTO JR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ERNESTO
Last Name:SOTO-GATES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:ERNESTO
Other - Last Name:SOTO
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:341 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3212
Mailing Address - Country:US
Mailing Address - Phone:541-342-8255
Mailing Address - Fax:541-342-7987
Practice Address - Street 1:341 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-342-8255
Practice Address - Fax:541-342-7987
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500740231Medicaid