Healthcare Provider Details

I. General information

NPI: 1609091925
Provider Name (Legal Business Name): SONJA SOTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40404 N GAVILAN PEAK PKWY
ANTHEM AZ
85086-2754
US

IV. Provider business mailing address

40404 N GAVILAN PEAK PKWY
ANTHEM AZ
85086-2754
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-8610
  • Fax: 623-445-8680
Mailing address:
  • Phone: 623-445-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN094352
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: