MEDICARE: MADISON ROSE SOTO NP

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	363LF0000X	Family Nurse Practitioner	95033571	CA

General Provider Information

NPI Number	:	1992649743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON ROSE SOTO NP

Provider Business Mailing Address
First Line	:	1123 ELEMENTS WAY
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-6501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6460 E PACIFIC COAST HWY STE 230
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4260
Country	:	US
Telephone Number	:	562-512-7900
Fax Number	:

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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