MEDICARE: MRS. ANA M HERNANDEZ-SOTO ASW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	31265	CA
2	104100000X	Social Worker	115212	CA

General Provider Information

NPI Number	:	1114088432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANA M HERNANDEZ-SOTO ASW

Provider Business Mailing Address
First Line	:	275 BECK AVE # MS 5120
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6804
Country	:	US
Telephone Number	:	707-784-8140
Fax Number	:	707-428-6542

Provider Business Practice Location Address
First Line	:	275 BECK AVE # MS 5120
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6804
Country	:	US
Telephone Number	:	707-784-8140
Fax Number	:	707-428-6542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	05/26/2023

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