MEDICARE: PEDRO J FIGUEROA SOTO

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	103TF0000X	Family Psychologist

General Provider Information

NPI Number	:	1417698853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO J FIGUEROA SOTO

Provider Business Mailing Address
First Line	:	1239 PARK AVE APT 2
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-5249
Country	:	US
Telephone Number	:	787-525-7320
Fax Number	:

Provider Business Practice Location Address
First Line	:	1239 PARK AVE APT 2
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-5249
Country	:	US
Telephone Number	:	787-525-7320
Fax Number	:

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

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	04/06/2022

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