Provider Demographics
NPI:1801229273
Name:SOTO GUTIERREZ, LEONARDO ROGELIO
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:ROGELIO
Last Name:SOTO GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4139
Mailing Address - Country:US
Mailing Address - Phone:323-720-9300
Mailing Address - Fax:323-720-9393
Practice Address - Street 1:1000 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4139
Practice Address - Country:US
Practice Address - Phone:323-720-9300
Practice Address - Fax:323-720-9393
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator