Provider Demographics
NPI:1336375625
Name:SOTO, NICOLE M (BA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:SOTO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-349 KUAHELANI AVE APT B2
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1179
Mailing Address - Country:US
Mailing Address - Phone:808-223-8378
Mailing Address - Fax:
Practice Address - Street 1:95-349 KUAHELANI AVE APT B2
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1179
Practice Address - Country:US
Practice Address - Phone:808-223-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health