Provider Demographics
NPI:1982269726
Name:SOTO, BRYANT (AMFT)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:SOTO
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WILSHIRE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1931
Mailing Address - Country:US
Mailing Address - Phone:213-481-7464
Mailing Address - Fax:213-481-7147
Practice Address - Street 1:1200 WILSHIRE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:213-481-7464
Practice Address - Fax:213-481-7147
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108874106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist