Healthcare Provider Details

I. General information

NPI: 1649153552
Provider Name (Legal Business Name): JOSE ANTONIO SORIA SOTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOSEFINA RENDON 518
TIJUANA BAJA CALIFORNIA
22435
MX

IV. Provider business mailing address

2498 ROLL DR # 2759
SAN DIEGO CA
92154-7279
US

V. Phone/Fax

Practice location:
  • Phone: 619-272-9021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE ANTONIO SORIA SOTO
Title or Position: DENTIST
Credential: DDS
Phone: 619-272-9021