Provider Demographics
NPI:1770722811
Name:SOTO, LISA ANNETTE
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNETTE
Last Name: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 1:116 REI TANG LOOP
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5331
Mailing Address - Country:US
Mailing Address - Phone:512-626-7240
Mailing Address - Fax:512-268-1328
Practice Address - Street 1:300 S STAGECOACH TRL
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5096
Practice Address - Country:US
Practice Address - Phone:512-392-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1416043174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist