Provider Demographics
NPI:1841308632
Name:SOTO, ALFREDO JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:JOSE
Last Name:SOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17695 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97136-9689
Mailing Address - Country:US
Mailing Address - Phone:503-548-7363
Mailing Address - Fax:
Practice Address - Street 1:182 SW ACADEMY ST
Practice Address - Street 2:SUITE 30
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1922
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:503-831-1726
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD216962084P0800X, 2084P0804X
MI43015059952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD21696OtherSTATE MEDICAL LICENSE
MO2019036194OtherSTATE MEDICAL LICENSE
OR122564Medicaid
OR122564Medicaid
OR122564Medicaid