Provider Demographics
NPI:1992207641
Name:SOTO, BRIAN ALEXANDER (CNP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ALEXANDER
Last Name:SOTO
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2224
Mailing Address - Country:US
Mailing Address - Phone:216-651-4145
Mailing Address - Fax:216-651-4145
Practice Address - Street 1:5209 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2224
Practice Address - Country:US
Practice Address - Phone:216-651-2037
Practice Address - Fax:216-651-4145
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH434715163W00000X
OHAPRN.CNP.023345363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH199220767641Medicaid